Renal sympathetic denervation for treatment of ventricular arrhythmias: a review on current experimental and clinical findings
Renal sympathetic denervation for treatment of ventricular arrhythmias: a review on current experimental and clinical findings
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去肾交感神经治疗室性心律失常：当前实验和临床研究结果综述
DOI：
10.1007/s00392-015-0812-9
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发表时间：
2015
影响因子：
5
通讯作者：
Jiang Hong
中科院分区：
文献类型：
--
作者：
Huang Bing;Scherlag Benjamin J.;Yu Lilei;Lu Zhibing;He Bo;Jiang Hong
室性心律失常（VA）仍然是几乎所有形式的心脏病中死亡和心源性猝死（SCD）的主要原因。尽管有这么多的治疗进展，如药物治疗，导管消融术，心律失常手术，VA的管理仍然是一个巨大的挑战，心脏病学家。来自组织学研究和直接神经活动记录的证据表明，交感神经密度和活动的增加有助于VA和SCD的产生。肾交感神经（renal sympathetic nerve，RSN）是中枢交感神经活动的重要调节成分，无论是传入成分还是传出成分。我们最近发现，通过电刺激激活RSN显著增加心脏和全身交感神经活动，并促进急性缺血诱导的VA的发生率，表明RSN在VA的发展中起作用。在顽固性高血压患者中进行RSN去神经（RDN）的初步经验表明，这种新型微创器械方法不仅显著减少了肾脏，而且还显著减少了全身去甲肾上腺素溢出。此外，实验研究发现，RDN后左星状神经节神经活动明显减少。基于这些观察结果，可以合理地得出结论，RDN可能是管理VA的有效疗法。事实上，RDN在动物模型和患者中都提供了针对VA的保护。在这篇文章中，我们回顾了RSN在VA和SCD的产生中的作用，以及RDN作为VA和SCD的潜在治疗策略的作用。
Ventricular arrhythmias (VAs) remain the major cause of mortality and sudden cardiac death (SCD) in almost all forms of heart disease. Despite so many therapeutic advances, such as pharmacological therapies, catheter ablation, and arrhythmia surgery, management of VAs remains a great challenge for cardiologists. Evidence from histological studies and from direct nerve activity recordings have suggested that increased sympathetic nerve density and activity contribute to the generation of VAs and SCD. It is well known that renal sympathetic nerve (RSN), either afferent component or efferent component, plays an important role in modulation of central sympathetic activity. We have recently shown that RSN activation by electrical stimulation significantly increases cardiac and systemic sympathetic activity and promotes the incidence of acute ischemia-induced VAs, suggesting RSN has a role in the development of VAs. Initial experience of RSN denervation (RDN) in patients with resistant hypertension showed that this novel and minimally invasive device-based approach significantly reduced not only kidney but also whole-body norepinephrine spillover. In addition, experimental studies find that left stellate ganglion nerve activity is significantly decreased after RDN. Based on these observations, it is reasonable to conclude that RDN may be an effective therapy for the management of VAs. Indeed, RDN has provided a protection against VAs in both animal models and patients. In this article, we review the role of the RSN in the generation of VAs and SCD and the role of RDN as a potential treatment strategy for VAs and SCD.