Electrical stimulation-based evaluation for functional modification of renal autonomic nerve activities induced by catheter ablation
Electrical stimulation-based evaluation for functional modification of renal autonomic nerve activities induced by catheter ablation
复制标题
基于电刺激的导管消融引起的肾自主神经活动功能改变的评估
DOI：
10.1016/j.hrthm.2016.04.021
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发表时间：
2016
期刊：
影响因子：
5.5
通讯作者：
Iwafuchi M.
中科院分区：
文献类型：
--
作者：
Chinushi M;Suzuki K;Saitoh O;Furushima H;Iijima K;Izumi D;Sato A;Sugai M;Iwafuchi M.
背景肾动脉导管消融术可以在血管造影无明显狭窄的情况下进行。目的探讨电神经刺激（ENS）引起的血压（BP）反应与肾动脉组织学损伤程度的关系。方法在8只犬的肾动脉中插入一根灌注导管，射频电流分别为15、20或25 W。结果消融前，ENS使血压和心率分别从145 ± 15/86 ± 13上升到189 ± 21/111 ± 19 mm Hg和116 ± 9上升到130 ± 6次/min。心率变异性指数和血清儿茶酚胺水平升高伴随。消融后，ENS引起的血压和心率升高在15 W消融后明显减弱，在20或25 W消融后几乎完全抑制。心率变异性指数和血清儿茶酚胺水平的增加变得微不足道，无论所施加的能量。肾动脉造影显示狭窄病变仅在25 W消融术后。组织学研究表明，20和25 W消融程序造成的动脉壁和自主神经的轻度至中度损伤，而只有轻微的变化所造成的15 W ablation.ConclusionFunctional肾自主神经消融术是潜在的ENS的指导下执行。
BackgroundCatheter ablation of the renal artery can be performed without apparent angiographic stenosis. This suggests that renal nerve function can be attenuated with minor structural damage to the renal artery.ObjectiveTo clarify this hypothesis, we examined the relationship between electrical nerve stimulation (ENS)–induced blood pressure (BP) response and severity of histological injury of the renal artery using an acute canine model of renal artery ablation.MethodsAn irrigation catheter was inserted into the renal arteries of 8 dogs, and radiofrequency current was delivered at 15, 20, or 25 W. ENS was applied to each artery before and after ablation.ResultsBefore ablation, ENS increased the BP and heart rate from 145 ± 15/86 ± 13 to 189 ± 21/111 ± 19 mm Hg and from 116 ± 9 to 130 ± 6 beats/min, respectively. Heart rate variability indices and serum catecholamine levels were elevated concomitantly. After ablation, the ENS-induced increase in BP and heart rate were markedly attenuated after 15 W ablation and those were nearly completely inhibited after 20 or 25 W ablation. An increase in heart rate variability indices and serum catecholamine levels became insignificant regardless of the applied energy. Renal artery angiograms revealed stenotic lesions only after 25 W ablation procedures. Histological studies showed mild to moderate injury of the arterial wall and autonomic nerves caused by 20 and 25 W ablation procedures, whereas only minor changes caused by 15 W ablation.ConclusionFunctional renal autonomic nerve ablation is potentially performable with the guidance of ENS.