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Radiofrequency catheter renal sympathetic nerve ablation for resistant hypertension

Radiofrequency catheter renal sympathetic nerve ablation for...

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第七届海峡两岸心血管科学研讨会

作者： Murray Esler Markus Schlaich Paul Sobotka Rob Whitbourn tony walton Henry Krum Baker IDI Heart and Diabetes Institute

Background:In essential hypertension,renal noradrenaline(NA)spillover is commonly increased and in experimental hypertension renal sympathectomy abolishes the blood pressure *** renal sympathetic nerve ablation with catheter-based radiofrequency energy(Symplicity,Ardian Inc.)was tested in patients with resistant hypertension(SBP above 160 mmHg on 3 or more anti-hypertensive drugs,including a diuretic).Methods: Office blood pressure(BP)and safety data were acquired prior to,and at 1,3,6 and 12 months post-procedure. Whole body and renal noradrenaline spillover were measured with isotope dilution in a subset of 10 patients at baseline and 30 days ***:45 pts with a baseline mean office blood pressure of 177/ 101 mmHg(SD 20/15),(mean 4.7 antihypertensive medications)were studied;office blood pressures after procedure were reduced by 14/10,21/10,22/11,24/11,and 27/17 mmHg at 1,3,6,9,and 12 months,respectively. Thirty days after denervation,mean reduction in total renal noradrenaline spillover was 47%,P=0.023 (95%CI 28%～65%),and total body NA spillover was reduced 28%,P =0.043(95%CI 4%～52%).One intra-procedural renal artery dissection occurred before radiofrequency energy delivery without further *** other renal vascular complications were identified with short term repeat angiographic studies or with CTA or MRA 6 months after the ablations Conclusions:Renal sympathetic nerve ablation is associated with reduction of renal NA spillover indicative of disabling of renal efferent sympathetic *** renal sympathetic nerves from the kidney to the brain influence central sympathetic output,and the observed reduction of total body NA spillover suggests renal sympathetic afferent traffic is *** afferent nerve disabling is a significant cause of the reduction of BP, the effect is expected to be lifelong,since these nerves have little capacity for *** disabling of renal sympathetic nerves is associated with

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