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Modulation of renal sympathetic innervation: recent insights beyond blood pressure control

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Abstract

Renal afferent and efferent sympathetic nerves are involved in the regulation of blood pressure and have a pathophysiological role in hypertension. Additionally, several conditions that frequently coexist with hypertension, such as heart failure, obstructive sleep apnea, atrial fibrillation, renal dysfunction, and metabolic syndrome, demonstrate enhanced sympathetic activity. Renal denervation (RDN) is an approach to reduce renal and whole body sympathetic activation. Experimental models indicate that RDN has the potential to lower blood pressure and prevent cardio-renal remodeling in chronic diseases associated with enhanced sympathetic activation. Studies have shown that RDN can reduce blood pressure in drug-naïve hypertensive patients and in hypertensive patients under drug treatment. Beyond its effects on blood pressure, sympathetic modulation by RDN has been shown to have profound effects on cardiac electrophysiology and cardiac arrhythmogenesis. RDN can display anti-arrhythmic effects in a variety of animal models for atrial fibrillation and ventricular arrhythmias. The first non-randomized studies demonstrate that RDN may promote the maintenance of sinus rhythm following catheter ablation in patients with atrial fibrillation. Registry data point towards a beneficial effect of RDN to prevent ventricular arrhythmias in patients with heart failure and electrical storm. Further large randomized placebo-controlled trials are needed to confirm the antihypertensive and anti-arrhythmic effects of RDN. Here, we will review the current literature on anti-arrhythmic effects of RDN with the focus on atrial fibrillation and ventricular arrhythmias. We will discuss new insights from preclinical and clinical mechanistic studies and possible clinical implications of RDN.

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Authors and Affiliations

  1. Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia

    Dominik Linz, Adrian D. Elliott, Dennis H. Lau & Prashanthan Sanders

  2. Kardiologie, Angiologie und Internistische Intensivmedizin, Universität des Saarlandes, Saarbrücken, Germany

    Mathias Hohl, Felix Mahfoud & Michael Böhm

  3. Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA

    Felix Mahfoud

  4. Human Neurotransmitters Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, Australia

    Murray D. Esler

  5. Centre for Heart Rhythm Disorders, Department of Cardiology, New Royal Adelaide Hospital, Adelaide, 5000, Australia

    Dominik Linz

Authors
  1. Dominik Linz
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  2. Mathias Hohl
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  3. Adrian D. Elliott
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  4. Dennis H. Lau
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  5. Felix Mahfoud
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  6. Murray D. Esler
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  7. Prashanthan Sanders
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  8. Michael Böhm
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Corresponding author

Correspondence to Dominik Linz.

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Conflict of interest

DL, FM, PS and MB received research grants, speaker honoraria, and consultancy fees from Medtronic/Ardian, St. Jude, Boston Scientific, and Cordis. The other authors report no conflicts.

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Linz, D., Hohl, M., Elliott, A.D. et al. Modulation of renal sympathetic innervation: recent insights beyond blood pressure control. Clin Auton Res 28, 375–384 (2018). https://doi.org/10.1007/s10286-018-0508-0

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  • DOI: https://doi.org/10.1007/s10286-018-0508-0

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