Transvascular Pacing of Aorticorenal Ganglia Provides a Testable Procedural Endpoint for Renal Artery Denervation
| Autor: | Jim Pouliopoulos, Stuart P. Thomas, John Ronquillo, Virginia James, Ashraf Mina, Pierre Qian, Michael A. Barry, Winny Varikatt, Juntang Lu, Shirley Alvarez, Sushil Bandodkar, Aravinda Thiagalingam |
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| Rok vydání: | 2019 |
| Předmět: |
Denervation
Aorta medicine.medical_specialty Aorticorenal ganglion business.industry 030204 cardiovascular system & hematology Inferior vena cava 03 medical and health sciences 0302 clinical medicine Blood pressure medicine.anatomical_structure medicine.vein Renal sympathetic denervation medicine.artery Internal medicine medicine Cardiology 030212 general & internal medicine medicine.symptom Renal artery Cardiology and Cardiovascular Medicine business Vasoconstriction |
| Zdroj: | JACC: Cardiovascular Interventions. 12:1109-1120 |
| ISSN: | 1936-8798 |
| DOI: | 10.1016/j.jcin.2019.04.047 |
| Popis: | Objectives This study sought to develop a method to assess renal sympathetic nerve function through localization and pacing of aorticorenal ganglia (ARG). Background Transcatheter renal denervation procedures often fail to produce complete renal denervation because of the lack of a physiological procedural endpoint. Methods High-frequency pacing was performed in the inferior vena cava and aorta in sheep (n = 19) to identify ARG pace-capture sites. Group A (n = 5) underwent injection at the ARG pace-capture site for histological verification, group B (n = 6) underwent unilateral irrigated radiofrequency ablation of ARG pace-capture sites and assessment of renal innervation at 1 week post-procedure; and group C (n = 8) underwent ARG pacing before and 2 to 3 weeks after unilateral microwave renal denervation. Results ARG pace-capture responses were observed at paired discrete sites above the ipsilateral renal artery eliciting a change in mean arterial blood pressure of 22.2 (interquartile range [IQR]: 15.5 to 34.3 mm Hg; p Conclusions Transvascular ARG pace-capture is feasible and recognized by concurrent hypertensive and ipsilateral renal arterial vasoconstrictive responses. Abolition of ARG pacing-induced vasoconstriction may indicate successful renal sympathetic denervation and serve as a physiological procedural endpoint to guide transcatheter renal denervation. |
| Databáze: | OpenAIRE |
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