title: Irrigated radiofrequency ablation catheter and electro-anatomical mapping with computerized tomography integration for renal artery sympathetic denervation.
abstract: Despite over 6 decades of progress in the development of pharmacological therapy for hypertension, severe drug-resistant hypertension remains a major problem. Endovascular radiofrequency ablation of the proximal renal arteries has been reported to decrease renal artery sympathetic activity and improve long-term hypertensive control. Existing "approved" catheters for this procedure are solid tip, non-irrigated, and often difficult to steer. The existing technique uses angiography and lends itself to increased risk of renal scarring and possible stenosis. We describe a patient with multi-drug resistant hypertension who underwent catheter ablation of the bilateral renal arteries, using for the first time, an open irrigated cardiac ablation catheter with both electro-anatomical guidance and computerized tomography anatomical integration. We used "off-label" irrigated catheters, which are less prone to overheating and char formation at the catheter-surface interface, thereby decreasing the possibility of distal embolization to the renal parenchyma. The integration of electro-anatomical mapping into this procedure allowed us to avoid inadvertent circumferential ablation of the artery using electro-anatomical mapping may lower the risk of subsequent renal artery stenosis.
authors.affiliation: University of Miami Miller School of Medicine Regional Campus, JFK Medical Center, Department of Internal Medicine, 5301 S. Congress Ave, Atlantis, FL 33462, USA. sshah7@med.miami.edu
authors.forename: Sachil
authors.initials: S
authors.lastname: Shah
authors.forename: Marcelo A
authors.initials: MA
authors.lastname: Jimenez
authors.forename: Robert S
authors.initials: RS
authors.lastname: Fishel
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D017115:Catheter Ablation / Q000379:methods*; D004351:Drug Resistance; D057510:Endovascular Procedures / Q000379:methods*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000601:surgery*; D008297:Male; D012077:Renal Artery / Q000294:innervation*; D012078:Renal Artery Obstruction / Q000453:epidemiology / Q000517:prevention & control; D012307:Risk Factors; D013562:Sympathectomy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents