title: Effects of renal sympathetic denervation on cardiac sympathetic activity and function in patients with therapy resistant hypertension.
abstract: BACKGROUND
  Renal sympathetic denervation (RSD) is currently being investigated in multiple studies of sympathetically driven cardiovascular diseases such as heart failure and arrhythmias. Our aim was to assess systemic and cardiac sympatholytic effects of RSD by the measurement of cardiac sympathetic activity and cardiovascular parameters.
  
  
  METHODS
  A total of 21 consecutive patients with refractory hypertension (daytime ambulatory blood pressure (BP)≥150/100 mmHg despite the use of 3 or more antihypertensive drugs), no evidence for secondary hypertension and normal renovascular anatomy were included. RSD was performed with the Medtronic Symplicity renal denervation catheter with an average of 4.2 (range 3-6) ablations per renal artery. To assess cardiac sympathetic activity, 123I-mIBG cardiac scintigraphy was performed before and 6 weeks after. In addition, the effect of RSD on peripheral BP and cardiac hemodynamics were assessed non-invasively.
  
  
  RESULTS
  123I-mIBG uptake before and after RSD was 1.7±0.4% vs. 1.7±0.5% at 15 min. and 1.4±0.4% vs. 1.5±0.5% after 4 h. As a consequence, washout rate was similar before (33.7±11.7%) and after RSD (30.1±12.6%, p=0.27). In line with earlier RSD studies, a significant drop in systolic office BP (-12.2 mmHg, p=0.04) was detected, whereas the decrease in ambulatory BP was not significant. No changes were seen in heart rate, stroke volume or left ventricular contractility, both in supine position and after standing.
  
  
  CONCLUSIONS
  In concert with previous reports, RSD leads to a significant drop in office BP. However, a reduction in sympathetic activity could not be demonstrated on a cardiac level.
authors.affiliation: Department of Cardiology of the Academic Medical Center, University of Amsterdam, The Netherlands. Electronic address: p.m.vanbrussel@amc.uva.nl.
authors.forename: Peter M
authors.initials: PM
authors.lastname: van Brussel
authors.affiliation: Department of Vascular Medicine of the Academic Medical Center, University of Amsterdam, The Netherlands.
authors.forename: Daan W
authors.initials: DW
authors.lastname: Eeftinck Schattenkerk
authors.affiliation: Department of Nephrology of the Academic Medical Center, University of Amsterdam, The Netherlands.
authors.forename: Linn C
authors.initials: LC
authors.lastname: Dobrowolski
authors.affiliation: Department of Cardiology of the Academic Medical Center, University of Amsterdam, The Netherlands.
authors.forename: Robbert J
authors.initials: RJ
authors.lastname: de Winter
authors.affiliation: Department of Radiology of the Academic Medical Center, University of Amsterdam, The Netherlands.
authors.forename: Jim A
authors.initials: JA
authors.lastname: Reekers
authors.affiliation: Department of Nuclear Medicine of the Academic Medical Center, University of Amsterdam, The Netherlands.
authors.forename: Hein J
authors.initials: HJ
authors.lastname: Verberne
authors.affiliation: Department of Nephrology of the Academic Medical Center, University of Amsterdam, The Netherlands.
authors.forename: Liffert
authors.initials: L
authors.lastname: Vogt
authors.affiliation: Department of Vascular Medicine of the Academic Medical Center, University of Amsterdam, The Netherlands.
authors.forename: Bert-Jan H
authors.initials: BJ
authors.lastname: van den Born
mesh_terms: D019797:3-Iodobenzylguanidine / Q000378:metabolism; D000368:Aged; D001795:Blood Pressure Determination / Q000295:instrumentation; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods; D002302:Cardiac Output / Q000502:physiology; D017115:Catheter Ablation / Q000379:methods*; D004351:Drug Resistance / Q000502:physiology; D005260:Female; D006321:Heart / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000503:physiopathology / Q000601:surgery*; D007668:Kidney / Q000098:blood supply* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods; D012077:Renal Artery / Q000294:innervation* / Q000601:surgery; D013562:Sympathectomy / Q000379:methods*; D013564:Sympathetic Nervous System / Q000502:physiology
chemical_list: D019797:3-Iodobenzylguanidine
keywords: (123)I-mIBG scintigraphy; Cardiac output; Renal sympathetic denervation; Sympathetic nerve activity