Oncotarget

Research Papers:

Renal sympathetic denervation guided by renal nerve stimulation to treat ventricular arrhythmia in CKD patients with ICD

Márcio Galindo Kiuchi _, Shaojie Chen, Luis Marcelo Rodrigues Paz and Helmut Pürerfellner

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Oncotarget. 2017; 8:37296-37307. https://doi.org/10.18632/oncotarget.16278

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Abstract

Márcio Galindo Kiuchi1,3, Shaojie Chen2,3, Luis Marcelo Rodrigues Paz1 and Helmut Pürerfellner3

1Department of Medicine, Division of Artificial Cardiac Stimulation, Hospital e Clínica São Gonçalo, São Gonçalo, Rio de Janeiro, Brazil

2Department of Cardiology, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

3Department of Cardiology, Elisabethinen University Teaching Hospital Linz, Linz, Austria

Correspondence to:

Márcio Galindo Kiuchi, email: [email protected]

Keywords: ventricular arrhythmias, anti-tachycardia therapy pacing, automatic cardioverter-defibrillator, chronic renal disease, renal sympathetic denervation

Received: February 01, 2017     Accepted: March 01, 2017     Published: March 16, 2017

ABSTRACT

Chronic kidney disease (CKD) patients on stage 4 present greater risk rates for malignant ventricular arrhythmia events. This study examined patients with CKD in stages 1, 2, 3 and 4, left ventricular dysfunction and automatic implantable cardioverter-defibrillator (ICD). Our goal was to record the appropriate therapies, “Anti-tachycardia Therapy Pacing” (ATP) and shock events during the 18 months of follow-up and compare the incidence and severity of these at different stages of CKD, mainly in patients with CKD stage 4 underwent renal sympathetic denervation (RSD) guided by renal nerve stimulation (RNS). One hundred and fifteen patients were evaluated once every three months till 18 months of follow-up. The arrhythmic events were assessed at each follow-up visit. Comparing the groups, we can see the number of ATP and shock events recorded by ICD during 18 months of follow-up, and differences in the number of therapeutic events between the various stages of CKD. The hazard ratio (HR), 95% confidence interval (CI) and P value for ATP and shock events between all the CKD stages were evaluated by the log-rank/Mantel-Haenszel test. At the 18th month of follow-up, 75% of patients with CKD stage 4 received ATP, and 70% were treated with shock while only 20% of the subjects with CKD stage 4 that were submitted to RSD received ATP and 20% were treated with shock, P<0.0001 and P=0.0002, respectively. In our study, a decline occurred in the incidence of arrhythmias, and therefore, appropriate ICD therapies in advanced stages of CKD, reducing the risk rates for these events in patients with CKD on stage 4 after RSD guided by RNS in comparison to the other CKD stages. Our results suggest that RSD can control the higher incidence of malignant arrhythmias in advanced CKD stages.


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