6 Month Outcomes in Patients WithImplantable Cardioverter-DefibrillatorsUndergoing Renal SympatheticDenervation for the Treatment ofRefractory Ventricular Arrhythmias

ABSTRACT

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 hyperactivityplays 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 ofventricular tachycardia (VT)/ventricular fibrillation (VF) episodes and device therapies (antitachycardia pacing/shocks) inthe 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 (range1 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; inboth cases, no further episodes occurred during follow-up. Two patients were nonresponders 1 with persistent idioventricularrhythm and 1 with multiple renal arteries and incomplete ablation. Three patients died during follow-up. Noneof the deaths was attributed to VA.CONCLUSIONS In patients with ICDs and refractory VAs, RSD was associated with reduced arrhythmic burden withno procedure-related complications. Randomized controlled trials investigating RSD for treatment of refractory VAs inpatients with increased sympathetic activity are needed.