Impact of Lesion Placement on Efficacy and Safety of Catheter-Based Radiofrequency Renal Denervation.
BACKGROUND
Insufficient procedural efficacy has been proposed to explain nonresponse to renal denervation (RDN).


OBJECTIVE
The aim of this study was to examine the impact of different patterns of lesion placements on the efficacy and consistency of catheter-based radiofrequency RDN in pigs.


METHODS
The impact of increasing number of lesions versus location of RDN was investigated in a porcine model (Group 1; n = 51). The effect of treating the main artery, the branches, and the 2 combined was compared in Group 2 (n = 48). The durability of response and safety of combined treatment of the main artery plus branches was examined in Group 3 (n = 16). Renal norepinephrine (NE) tissue content and renal cortical axon density were assessed.


RESULTS
Increasing the number of RF lesions (4, 8, and 12) in the main renal artery was not sufficient to yield a clear dose-response relationship on NE content and axon density. In contrast, targeted treatment of the renal artery branches or distal segment of the main renal artery resulted in markedly less variability of response and significantly greater reduction of both NE and axon density than conventional treatment of only the main renal artery. Combination treatment (main artery plus branches) produced the greatest change in renal NE and axon density with the least heterogeneity. The changes were durable through 28 days post-treatment.


CONCLUSIONS
These data provide the rationale for investigation of an optimized approach for RDN in future clinical studies. This may have profound implications for the clinical application of RDN, as this approach may not only achieve greater reductions in sympathetic activity but also reduce treatment effect variability.
Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany. Electronic address: felix.mahfoud@uks.eu.
Felix
F
Mahfoud
Medtronic Cardiovascular, Santa Rosa, California.
Stefan
S
Tunev
Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
Sebastian
S
Ewen
Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
Bodo
B
Cremers
Medtronic Cardiovascular, Santa Rosa, California.
Jennifer
J
Ruwart
Medtronic Cardiovascular, Santa Rosa, California.
Daniel
D
Schulz-Jander
Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
Dominik
D
Linz
International Centre for Circulatory Health, Imperial College London, Hammersmith Hospital, London, United Kingdom.
Justin
J
Davies
Piedmont Heart Institute, Atlanta, Georgia.
David E
DE
Kandzari
The Cardiovascular Research Centre, St. Vincent's Hospital Melbourne, Melbourne, Australia.
Robert
R
Whitbourn
Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
Michael
M
Böhm
Medtronic Cardiovascular, Santa Rosa, California.
Robert J
RJ
Melder
D000818:Animals; D001369:Axons; D017115:Catheter Ablation / Q000379:methods*; D002452:Cell Count; D003714:Denervation / Q000379:methods*; D005260:Female; D007668:Kidney / Q000294:innervation*; D008297:Male; D012077:Renal Artery / Q000601:surgery*; D013552:Swine
branch treatment; optimized techniques; resistant hypertension