title: Renal sympathetic denervation using an irrigated radiofrequency ablation catheter for the management of drug-resistant hypertension.
abstract: OBJECTIVE
  This study sought to assess whether renal sympathetic denervation (RSDN) can be achieved using an off-the-shelf saline-irrigated radiofrequency ablation (RFA) catheter typically employed for cardiac tissue ablation.
  
  
  BACKGROUND
  RSDN using a specialized solid-tip RFA catheter has recently been demonstrated to safely reduce systemic blood pressure in patients with refractory hypertension. For cardiac tissue ablation, RFA technology has evolved from nonirrigated to saline-irrigated ablation electrodes to improve both safety and effectiveness.
  
  
  METHODS
  Ten patients with resistant hypertension underwent renal angiography, followed by bilateral RSDN with a saline-irrigated RFA catheter. Ambulatory blood pressure recordings (24 h) were obtained at baseline, 1, 3, and 6 months after the procedure. Repeat renal angiography was performed during follow-up to assess for arterial stenosis or aneurysm. In 5 patients, pre- and post-procedural serum measures of renal function and sympathetic activity were obtained: aldosterone; metanephrine; normetanephrine; plasma renin activity; and creatinine.
  
  
  RESULTS
  Over a 6-month period: 1) the systolic/diastolic blood pressure decreased by -21/-11 mm Hg; 2) all patients experienced a decrease in systolic blood pressure of at least 10 mm Hg (range 10 to 40 mm Hg); 3) there was no evidence of renal artery stenosis or aneurysm at repeat angiography; and 4) there was a significant decrease in metanephrine (-12 ± 4, p = 0.003), normetanephrine (-18 ± 4, p = 0.0008), and aldosterone levels (-60 ± 33 ng/l, p = 0.02) at 3 months. There was no significant change in plasma renin activity (-0.2 mg/l/hod, p = 0.4). There was no significant change in serum creatinine (-1 mmol/l, p = 0.4).
  
  
  CONCLUSIONS
  These data provide the proof-of-principle that RSDN can be performed using an off-the-shelf saline-irrigated RFA catheter.
authors: Cardiac Arrhythmia Service of Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029, USA.
authors: Humera
authors: H
authors: Ahmed
authors: Petr
authors: P
authors: Neuzil
authors: Jan
authors: J
authors: Skoda
authors: Jan
authors: J
authors: Petru
authors: Lucie
authors: L
authors: Sediva
authors: Marcela
authors: M
authors: Schejbalova
authors: Vivek Y
authors: VY
authors: Reddy
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D017115:Catheter Ablation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012077:Renal Artery / Q000294:innervation / Q000473:pathology / Q000601:surgery*; D013562:Sympathectomy / Q000379:methods*; D013564:Sympathetic Nervous System / Q000601:surgery*; D017211:Treatment Failure
chemical_list: D000959:Antihypertensive Agents