Role of Adjuvant Renal Sympathetic Denervation in the Treatment of Ventricular Arrhythmias

Ventricular arrhythmias (VAs) are known to result in significant morbidity and mortality rates in patients with both ischemic and nonischemic dilated cardiomyopathy. Although catheter ablation has emerged as an adjunct treatment strategy in the management of VAs, 1-year follow-up data have revealed that ventricular tachycardia (VT) free survival rate is similar to 50%. Up to now, a few small case series with short-term follow-up have reported reduced VT recurrence after application of renal sympathetic denervation (RSDN) in patients with refractory VAs. In this study, we aimed to investigate the safety and efficacy of RSDN as an adjunctive therapy to catheter ablation for refractory VAs in patients with dilated cardiomyopathy. For this purpose, we conducted a retrospective, propensity score matched cohort study. A total of 32 patients with implantable cardioverter-defibrillators (ICDs) who underwent catheter ablation or both catheter ablation and RSDN for refractory VAs were included in the analysis. Patients were followed up at a median of 15 months (6 to 20 months). Patient groups did not differ regarding the mean number of VT/ventricular fibrillation episodes in the last 6 months before the procedure (35.00 +/- 4.10 in catheter ablation only group vs 43.00 +/- 5.30 in catheter ablation + RSDN group, p = 0.23). There was a significant decrease in burden of both VT/ventricular fibrillation and antitachycardia pacing and shock therapies delivered from ICDs in the patient group that received RSDN as an adjunct therapy (p <0.05). Mortality rates were similar in 2 groups (p >0.05). In conclusion, our findings suggest that adjunctive RSDN is a safe and effective method for reducing the arrhythmic burden in patients with refractory VAs. In the future, it may be performed routinely in patients with ICDs and refractory VAs. (C) 2016 Elsevier Inc. All rights reserved.