title: Safety and efficacy of renal denervation as a novel treatment of ventricular tachycardia storm in patients with cardiomyopathy.
abstract: BACKGROUND
  Modulation of the autonomic nervous system has been used to treat refractory ventricular tachycardia (VT). Renal artery denervation (RDN) is under investigation for the treatment of sympathetic-driven cardiovascular diseases.
  
  
  OBJECTIVE
  The purpose of this study was to report the largest case series to date using RDN as adjunctive therapy for refractory VT in patients with underlying cardiomyopathy.
  
  
  METHODS
  Four patients with cardiomyopathy (2 nonischemic, 2 ischemic) with recurrent VT despite maximized antiarrhythmic therapy and prior endocardial (n = 2) or endocardial/epicardial (n = 2) ablation underwent RDN ± repeat VT ablation. RDN was performed spirally along each main renal artery with either a nonirrigated (6 W at 50°C for 60 seconds) or an open irrigated ablation catheter (10-12 W for 30-60 seconds). Renal arteriography was performed before and after RDN.
  
  
  RESULTS
  RDN was well tolerated acutely and demonstrated no clinically significant complications during follow-up of 8.8 ± 2.6 months (range 5.0-11.0 months). No hemodynamic deterioration or worsening of renal function was observed. The number of VT episodes was decreased from 11.0 ± 4.2 (5.0-14.0) during the month before ablation to 0.3 ± 0.1 (0.2-0.4) per month after ablation. All VT episodes occurred in the first 4 months after ablation (2.6 ± 1.5 months). The responses to RDN were similar for ischemic and nonischemic patients.
  
  
  CONCLUSIONS
  This case series provides promising preliminary data on the safety and effectiveness of RDN as an adjunctive therapy in the treatment of patients with cardiomyopathy and VT resistant to standard interventions.
authors.affiliation: Division of Cardiology, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Remo
authors.affiliation: The Valley Health System and Columbia University College of Physicians and Surgeons, New York, New York and Ridgewood, New Jersey.
authors.forename: Mark
authors.initials: M
authors.lastname: Preminger
authors.affiliation: UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors.forename: Jason
authors.initials: J
authors.lastname: Bradfield
authors.affiliation: The Valley Health System and Columbia University College of Physicians and Surgeons, New York, New York and Ridgewood, New Jersey.
authors.forename: Suneet
authors.initials: S
authors.lastname: Mittal
authors.affiliation: UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors.forename: Noel
authors.initials: N
authors.lastname: Boyle
authors.affiliation: Division of Cardiology, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Anuj
authors.initials: A
authors.lastname: Gupta
authors.affiliation: UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors.forename: Kalyanam
authors.initials: K
authors.lastname: Shivkumar
authors.affiliation: The Valley Health System and Columbia University College of Physicians and Surgeons, New York, New York and Ridgewood, New Jersey.
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Steinberg
authors.affiliation: Division of Cardiology, University of Maryland School of Medicine, Baltimore, Maryland. Electronic address: tdickfel@medicine.umaryland.edu.
authors.forename: Timm
authors.initials: T
authors.lastname: Dickfeld
mesh_terms: D000369:Aged, 80 and over; D017763:Autonomic Denervation / Q000379:methods; D009202:Cardiomyopathies / Q000150:complications*; D005260:Female; D006801:Humans; D007668:Kidney / Q000294:innervation*; D008297:Male; D008875:Middle Aged; D017180:Tachycardia, Ventricular / Q000601:surgery*; D016896:Treatment Outcome
keywords: Cardiomyopathy; Renal denervation; Ventricular tachycardia; Ventricular tachycardia storm