title: Proof of concept study: renal sympathetic denervation for treatment of polymorphic premature ventricular complexes.
abstract: OBJECTIVE
  Polymorphic premature ventricular complexes (PVCs) are very common, appearing most frequently in patients with hypertension, obesity, sleep apnea, and structural heart disease. Sympathetic hyperactivity plays a critical role in the development, maintenance, and aggravation of ventricular arrhythmias. Recently, the relevance of sympathetic activation in patients with ventricular arrhythmias was reported, and this finding suggested a potential role for catheter-based renal sympathetic denervation in reducing the arrhythmic burden.
  
  
  METHODS
  We evaluated the effectiveness of the renal sympathetic denervation (RSD) in comparison to antiarrhythmic pharmacologic therapy in reducing polymorphic PVCs refractory to medication therapy and cardiac parameters assessed by 24-h Holter monitoring and cardiac magnetic resonance (CRM), respectively, in patients with structurally normal heart.
  
  
  RESULTS
  Thirty-four patients were included in this study, 14 served as control, and 20 were treated with an ablation cardiac catheter with open irrigated tip. RSD was performed by a single operator following the standard technique. All the patients included had polymorphic PVCs and structurally normal heart. Data were obtained at baseline at the 12th month of follow-up (sixth month after RSD or adjustment of antiarrhythmic dosage). In RSD group, we observed a significant decrease in the number of polymorphic PVCs from baseline 36,091 ± 3327 to 3, 6, 7 (first month after RSD, without drugs), and 12 months (sixth month after RSD, without drugs) of follow-up, 31,009 ± 3251, 20,411 ± 3820, 7701 ± 1549, and 1274 ± 749, respectively, in all patients, P < 0.0001 to all the comparisons between the mean of each time point with the mean of every other time point. No changes in mean 24-h ABPM and renal function in both groups were observed at 12th month of follow-up. However, 24-h Holter mean heart rate decreased in control group at 12th month of follow-up, which did not happen with the RSD group. At the sixth month post-RSD in comparison to baseline, a significant reduction in the number of polymorphic PVCs (∆ = -34,817 ± 3590, P < 0.0001) was observed, as well as, in CRM parameters such as left ventricular mass/body surface area (∆ = -5.4 ± 2.1 g/m2, P < 0.0001) and left ventricular ejection fraction (∆ = +3.0 ± 1.8 %, P < 0.0001). In comparison to control group at the same time point, these findings were statistically superior in RSD group (P > 0.05). A significant correlation was found between the Δ number of polymorphic PVCs at the sixth month (r = -0.6723, P = 0.0012) after the RSD and the total number of RSD ablated spots.
  
  
  CONCLUSIONS
  Polymorphic PVCs refractory to medication therapy may be modifiable by RSD in patients without structural heart disease. Although encouraging, our data are preliminary and need to be validated in a large population and in long term.
authors.affiliation: Department of Cardiac Surgery and Artificial Cardiac Stimulation, Department of Medicine, Hospital e Clínica São Gonçalo, São Gonçalo, RJ, Brazil. marciokiuchi@gmail.com.|Electrophysiology Division, Department of Cardiology, Hospital e Clínica São Gonçalo, São Gonçalo, RJ, Brazil. marciokiuchi@gmail.com.
authors.forename: Márcio Galindo
authors.initials: MG
authors.lastname: Kiuchi
authors.affiliation: Department of Cardiac Surgery and Artificial Cardiac Stimulation, Department of Medicine, Hospital e Clínica São Gonçalo, São Gonçalo, RJ, Brazil.
authors.forename: Gustavo Ramalho
authors.initials: GR
authors.lastname: E Silva
authors.affiliation: Interventional Cardiology Section, Department of Cardiology, Hospital e Clínica São Gonçalo, São Gonçalo, RJ, Brazil.
authors.forename: Luis Marcelo Rodrigues
authors.initials: LM
authors.lastname: Paz
authors.affiliation: Department of Cardiology, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.|Fellowship of European Heart Rhythm Association / European Society of Cardiology, Department of Cardiology, Elisabethinen University Teaching Hospital Linz, Linz, Austria.
authors.forename: Shaojie
authors.initials: S
authors.lastname: Chen
authors.affiliation: Department of Cardiac Surgery and Artificial Cardiac Stimulation, Department of Medicine, Hospital e Clínica São Gonçalo, São Gonçalo, RJ, Brazil.
authors.forename: Gladyston Luiz Lima
authors.initials: GL
authors.lastname: Souto
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007668:Kidney / Q000294:innervation* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D013562:Sympathectomy / Q000379:methods*; D016896:Treatment Outcome; D018879:Ventricular Premature Complexes / Q000175:diagnosis* / Q000628:therapy*
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: Cardiac magnetic resonance; Polymorphic premature ventricular complexes; Renal sympathetic denervation; Structurally normal heart; Sympathetic hyperactivity; Ventricular arrhythmias