Effects of Renal Artery Denervation on Ventricular Arrhythmias in a Postinfarct Model
Effects of Renal Artery Denervation on Ventricular Arrhythmias in a Postinfarct Model
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DOI：
10.1161/circinterventions.116.004172
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发表时间：
2017-03-01
影响因子：
5.6
通讯作者：
Nanthakumar, Kumaraswamy
中科院分区：
文献类型：
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作者：
Jackson, Nicholas;Gizurarson, Sigfus;Nanthakumar, Kumaraswamy
背景-去肾神经支配（RDN）治疗心律失常的潜力还没有被充分探讨.详细的机械评估是有序的。本研究的目的是确定RDN在postinfarction动物模型中的抗心律失常潜力，并确定是否有任何好处与RDN诱导的交感神经效应器减少对myocardial.Methods和Results-Pigs植入单腔植入式心律转复除颤器记录室性心律失常（VA）进行经皮冠状动脉闭塞诱导心肌梗死。两周后，使用St Jude EnligHTN网篮导管进行双侧假或真实的RDN治疗。观察心肌梗死后3周心室重构和心肾交感神经轴的变化。肾动脉的组织学分析得出了健康神经的平均神经丝评分，真实的RDN组显著低于假手术对照组;仅在真实的RDN组中发现了受损神经。真实的RDN后自发性VA的发生率降低100%，假RDN后自发性VA的发生率增加75%（P = 0.03）。在梗死心肌中，RDN组交感神经的存在和神经肽Y（交感神经活动的指标）的组织丰度显著降低。峰值和平均窦性心动过速率显着降低后RDN.Conclusions RDN在梗死猪模型导致梗死后VA和心肌交感效应减少。这可能是RDN在梗死后VA中潜在治疗作用的基础。
Background- The therapeutic potential of renal denervation (RDN) for arrhythmias has not been fully explored. Detailed mechanistic evaluation is in order. The objective of the present study was to determine the antiarrhythmic potential of RDN in a postinfarct animal model and to determine whether any benefits relate to RDN-induced reduction of sympathetic effectors on the myocardium.Methods and Results-Pigs implanted with single-chamber implantable cardioverter defibrillators to record ventricular arrhythmias (VAs) were subjected to percutaneous coronary occlusion to induce myocardial infarction. Two weeks later, a sham or real RDN treatment was performed bilaterally using the St Jude EnligHTN basket catheter. Parameters of ventricular remodeling and modulation of cardio-renal sympathetic axis were monitored for 3 weeks after myocardial infarction. Histological analysis of renal arteries yielded a mean neurofilament score of healthy nerves that was significantly lower in the real RDN group than in sham controls; damaged nerves were found only in the real RDN group. There was a 100% reduction in the rate of spontaneous VAs after real RDN and a 75% increase in the rate of spontaneous VAs after sham RDN (P=0.03). In the infarcted myocardium, presence of sympathetic nerves and tissue abundance of neuropeptide-Y, an indicator of sympathetic nerve activities, were significantly lower in the RDN group. Peak and mean sinus tachycardia rates were significantly reduced after RDN.Conclusions-RDN in the infarcted pig model leads to reduction of postinfarction VAs and myocardial sympathetic effectors. This may form the basis for a potential therapeutic role of RDN in postinfarct VAs.