New Research Paper
Neuromodulation–Ventricular Arrhythmia
Renal Denervation for the Management of Refractory Ventricular Arrhythmias: A Systematic Review

https://doi.org/10.1016/j.jacep.2020.07.019Get rights and content
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Abstract

Objectives

The authors performed a systematic review and meta-analysis to determine the efficacy of renal denervation (RDN) in patients with refractory ventricular arrhythmias (VA) or electrical storm (ES).

Background

Although catheter ablation is efficacious for the treatment of structural heart disease ventricular tachycardia (VT), there are proportion of patients who have refractory VT despite multiple procedures. In this setting, novel adjunctive therapies such as renal denervation have been performed.

Methods

A systematic review of published data was performed. Studies that evaluated patients undergoing RDN for VA or ES were included. Outcome measures of VA, sudden cardiac death, ES, or device therapy were required. Case reports, editorials, and conference presentations were excluded. Random effects meta-analysis was conducted to explore change or final mean values in the study outcomes.

Results

A total of 328 articles were identified by the literature search. Seven studies met the eligibility criteria and were included in the systematic review, with a total of 121 pooled patients. The weighted mean age was 63.8 ± 13.1 years, ejection fraction 30.5 ± 10.3%, 76% were men, 99% were on a beta blocker, 79% were on amiodarone, 46% had previously undergone catheter ablation, and 8.3% had previously undergone cardiac sympathetic denervation. Meta-analysis demonstrated a significant effect of RDN in reducing implantable cardiac defibrillator therapies, with a standardized mean difference (SMD) of −3.11 (p < 0.001). RDN also reduced the number of VA episodes (SMD −2.13; p < 0.001), antitachycardia pacing episodes (SMD −2.82; p = 0.002), and shocks (SMD −2.82; p = 0.002).

Conclusions

RDN is an effective treatment for refractory VAs and ES, although randomized data are lacking.

Key Words

electrical storm
meta-analysis
renal denervation
sudden cardiac death
systematic review
ventricular arrhythmias
ventricular fibrillation
ventricular tachycardia

Abbreviations and Acronyms

ATP
antitachycardia pacing
CSD
cardiac sympathetic denervation
ES
electrical storm
ICD
implantable cardioverter defibrillator
RDN
renal denervation
SCD
sudden cardiac death
VA
ventricular arrhythmia
VT
ventricular tachycardia

Cited by (0)

Harikrishna Tandri, MD, served as Guest Editor for this paper. William Stevenson, MD, served as Guest Editor-in-Chief for this paper.

The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the Author Center.