Australia: Renal denervation is an effective treatment for refractory ventricular arrhythmias (VA) or electrical storm (ES), suggests a recent study in the journal JACC: Clinical Electrophysiology.
Catheter ablation is effective for the treatment of structural heart disease ventricular tachycardia (VT) but still, there are some patients who have refractory VT despite multiple procedures. In this scenario, the doctors perform novel adjunctive therapies such as renal denervation. Joshua Hawson, Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia, and colleagues performed a systematic review and meta-analysis of published data to determine whether renal denervation is effective in patients with refractory ventricular arrhythmias or electrical storm.
It included studies that evaluated patients undergoing RDN for VA or ES. Outcome measures of VA, sudden cardiac death, ES, or device therapy were required. It excluded case reports, editorials, and conference presentations.
The literature search helped in the identification of a total of 328 articles. Seven studies that met the eligibility criteria were included, with a total of 121 pooled patients. The weighted mean age was 63.8 ± 13.1 years, ejection fraction 30.5 ± 10.3%, 76% were men, 99% were on a beta-blocker, 79% were on amiodarone, 46% had previously undergone catheter ablation, and 8.3% had previously undergone cardiac sympathetic denervation.
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Key findings of the study include:
Meta-analysis demonstrated a significant effect of RDN in reducing implantable cardiac defibrillator therapies, with a standardized mean difference (SMD) of −3.11.
RDN also reduced the number of VA episodes (SMD −2.13), antitachycardia pacing episodes (SMD −2.82), and shocks (SMD −2.82).
"Further randomized trials are warranted to confirm the efficacy of RDN for the treatment of refractory VAs and electrical storm," concluded the authors.
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The study, "Renal Denervation for the Management of Refractory Ventricular Arrhythmias: A Systematic Review," is published in the journal JACC: Clinical Electrophysiology.
DOI: https://electrophysiology.onlinejacc.org/content/early/2020/09/26/j.jacep.2020.07.019