title: 6-Month Outcomes in Patients With Implantable Cardioverter-Defibrillators Undergoing Renal Sympathetic Denervation for the Treatment of Refractory Ventricular Arrhythmias.
abstract: OBJECTIVE
  This study aimed to assess 6-month outcomes in patients with implantable cardioverter-defibrillators (ICDs) undergoing renal sympathetic denervation (RSD) for refractory ventricular arrhythmias (VAs).
  
  
  BACKGROUND
  ICDs are generally indicated for patients at high risk of malignant VAs. Sympathetic hyperactivity plays a critical role in the development, maintenance, and aggravation of VAs.
  
  
  METHODS
  A total of 10 patients with refractory VA underwent RSD. Underlying conditions were Chagas disease (n = 6), nonischemic dilated cardiomyopathy (n = 2), and ischemic cardiomyopathy (n = 2). Information on the number of ventricular tachycardia (VT)/ventricular fibrillation (VF) episodes and device therapies (antitachycardia pacing/shocks) in the previous 6 months as well as 1 and 6 months post-treatment was obtained from ICD interrogation.
  
  
  RESULTS
  The median number of VT/VF episodes/antitachycardia pacing/shocks 6 months before RSD was 28.5 (range 1 to 106)/20.5 (range 0 to 52)/8 (range 0 to 88), respectively, and was reduced to 1 (range 0 to 17)/0 (range 0 to 7)/0 (range 0 to 3) at 1 month and 0 (range 0 to 9)/0 (range 0 to 7)/0 (range 0 to 3) at 6 months afterward, respectively. There were no major procedure-related complications. Two patients experienced sustained VT within the first week; in both cases, no further episodes occurred during follow-up. Two patients were nonresponders: 1 with persistent idioventricular rhythm and 1 with multiple renal arteries and incomplete ablation. Three patients died during follow-up. None of the deaths was attributed to VA.
  
  
  CONCLUSIONS
  In patients with ICDs and refractory VAs, RSD was associated with reduced arrhythmic burden with no procedure-related complications. Randomized controlled trials investigating RSD for treatment of refractory VAs in patients with increased sympathetic activity are needed.
authors.affiliation: Dante Pazzanese Institute of Cardiology, São Paulo, Brazil. Electronic address: luciana_va@hotmail.com.
authors.forename: Luciana V
authors.initials: LV
authors.lastname: Armaganijan
authors.affiliation: Dante Pazzanese Institute of Cardiology, São Paulo, Brazil.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Staico
authors.affiliation: Dante Pazzanese Institute of Cardiology, São Paulo, Brazil.
authors.forename: Dalmo A R
authors.initials: DA
authors.lastname: Moreira
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina; Brazilian Clinical Research Institute, São Paulo, Brazil.
authors.forename: Renato D
authors.initials: RD
authors.lastname: Lopes
authors.affiliation: Dante Pazzanese Institute of Cardiology, São Paulo, Brazil.
authors.forename: Paulo T J
authors.initials: PT
authors.lastname: Medeiros
authors.affiliation: Dante Pazzanese Institute of Cardiology, São Paulo, Brazil.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Habib
authors.affiliation: Dante Pazzanese Institute of Cardiology, São Paulo, Brazil.
authors.forename: Jônatas
authors.initials: J
authors.lastname: Melo Neto
authors.affiliation: Brazilian Clinical Research Institute, São Paulo, Brazil.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Katz
authors.affiliation: Dante Pazzanese Institute of Cardiology, São Paulo, Brazil.
authors.forename: Dikran
authors.initials: D
authors.lastname: Armaganijan
authors.affiliation: Dante Pazzanese Institute of Cardiology, São Paulo, Brazil.
authors.forename: Amanda G M R
authors.initials: AG
authors.lastname: Sousa
authors.affiliation: Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistiche Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany; Harvard-MIT Biomedical Engineering, Institute of Medical Engineering and Science, Cambridge, Massachusetts.
authors.forename: Felix
authors.initials: F
authors.lastname: Mahfoud
authors.affiliation: Dante Pazzanese Institute of Cardiology, São Paulo, Brazil.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Abizaid
mesh_terms: D000368:Aged; D001938:Brazil; D017115:Catheter Ablation / Q000009:adverse effects; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007668:Kidney / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012077:Renal Artery / Q000294:innervation*; D012307:Risk Factors; D013562:Sympathectomy / Q000009:adverse effects / Q000379:methods*; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*
keywords: implantable cardiac defibrillators; renal denervation; sympathetic activity; ventricular arrhythmias