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Renal denervation benefits in heart failure

RDN leads to better outcomes than standard drug treatment in patients with advanced heart failure, according to research1 presented at this year’s ESC Congress, held in Munich, Germany.

The Olomouc I pilot study aimed to compare the outcomes of patients with advanced heart failure receiving standard pharmacological treatment or RDN. Over the period of one year, 26 patients were treated with RDN antd standard pharmacotherapy and 25 patients received standard drug treatment with beta-blockers, angiotensin-converting-enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) and diuretics.

After one year contractile function of the left side of the heart improved in patients treated with RDN from 25±12% to 31±14% (p<0.01).

There was no change in contractile function of the left side of the heart in patients who received standard drug treatment. “The improvement of the contractile function of the left side of the heart by more than 10% in patients after RDN was a surprise,” said Dr Miloš Táborský (Olomouc University Hospital, Czech Republic). “This parameter has practically not changed in patients treated by the classic drugs. The difference in response might be explained by a continuous decrease of the renal sympathetic activity in the complex pathophysiology of heart failure.”

Dr Miloš Táborský

Dr Miloš Táborský

During the one year follow-up, 8 patients treated with RDN were hospitalized due to heart failure compared to 18 patients treated with standard drug therapy. Dr Táborský said: “Twice the number of patients treated by classic pharmacological therapy were taken to hospital due to heart failure.”

The disadvantage of denervation, as with any invasive treatment, is the potential for subsequent complications. “We have registered two complications – the formation of a fistula by the artery and the vein in the place of puncture and the formation of thrombi despite all safety measures being adhered to,” said Dr Táborský. “We have successfully removed both complications by a surgical revision and thromboaspiration.”

The findings indicate that RDN may be a non-pharmacological alternative for the treatment of patients with advanced heart failure and may help stabilise the disease. “RDN is particularly suited for patients without an extensive scar after myocardial infarction and whose heart rate increases when they are treated with the maximum tolerated dose of beta-blockers,” added Dr Táborský.

He concluded: “The long-term effects of RDN should be confirmed in a large international randomised study.”

References

1. Taborsky M, Lazarova ML, Vaclavik J. The effect of renal denervation in patients with advanced heart failure. European Heart Journal 2012;33 (Abstract Supplement):517.

Published on: September 27, 2012

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