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Clinical Research in Cardiology
Published in: Clinical Research in Cardiology 5/2020

01-05-2020 | Neurotomy | Original Paper

Effects of renal denervation on 24-h heart rate and heart rate variability in resistant hypertension

Authors: Christian Ukena, Tobias Seidel, Konstantinos Rizas, Davide Scarsi, Dominic Millenaar, Sebastian Ewen, Axel Bauer, Felix Mahfoud, Michael Böhm

Published in: Clinical Research in Cardiology | Issue 5/2020

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Abstract

Background

Catheter-based renal sympathetic denervation (RDN) can reduce sympathetic activity and blood pressure (BP) in patients with hypertension. The present study aimed at investigating the effects of RDN on heart rate (HR), number of premature captions, and heart rate variability (HRV).

Methods

A total of 105 patients (67% male, age 63.5 ± 10 years) with resistant hypertension (BP 169 ± 22/89 ± 14 mmHg) underwent bilateral RDN using a radiofrequency catheter (Symplicity Flex, Medtronic). 24-h Holter monitoring was performed at baseline and after 6 months. Besides HR profile, the number of premature atrial (PAC) and ventricular captions (PVC), time and frequency domain-based HRV were analyzed. Data are presented as mean ± standard deviation or median (interquartile range).

Results

Office systolic and diastolic BP were reduced after RDN by 21.8 ± 25.2 mmHg and 8 ± 18.7 mmHg (p < 0.001 for both), respectively. Twenty-eight (27%) patients had a reduction of < 10 mmHg in systolic BP. At baseline, mean 24-h HR was 65.7 ± 9.9 bpm. The prevalence of PAC [median 1.2 (0.3–6.2)] and PVC [median 1.2 (0.1–13.9)] was low and values of HRV were within normal limits and not different between responders and non-responders. After 6 months, patients with a baseline HR > 72 min had a significant reduction in HR by 2.3 ± 7.1 bpm. Parameters of HRV did not significantly change during follow-up. In patients with ≥ 6 PAC per hour at baseline, a significant median reduction of − 12.4 (− 37.4 to − 2.3) PAC after 6 months was documented (p = 0.002), which occurred independently from BP effects. The number of PVC was not significantly altered after RDN.

Conclusion

In patients with resistant hypertension and elevated HR or high burden of PACs, RDN was associated with a reduction of HR and number of PAC. Parameters of HRV were not changed after RDN nor were predictive of response to RDN.
Literature
1.
Böhm M, Linz D, Ukena C, Esler M, Mahfoud F (2014) Renal denervation for the treatment of cardiovascular high risk-hypertension or beyond? Circ Res 115:400–409CrossRef
2.
Schroeder EB, Liao D, Chambless LE, Prineas RJ, Evans GW, Heiss G (2003) Hypertension, blood pressure, and heart rate variability: the atherosclerosis risk in communities (ARIC) study. Hypertension 42:1106–1111CrossRef
3.
Eckberg DL (1997) Sympathovagal balance: a critical appraisal. Circulation 96:3224–3232CrossRef
4.
Krum H, Schlaich M, Whitbourn R, Sobotka PA, Sadowski J, Bartus K et al (2009) Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study. Lancet 373:1275–1281CrossRef
5.
Schlaich MP, Sobotka PA, Krum H, Lambert E, Esler MD (2009) Renal sympathetic-nerve ablation for uncontrolled hypertension. New Engl J Med 361:932–934CrossRef
6.
Hering D, Lambert EA, Marusic P, Walton AS, Krum H, Lambert GW et al (2013) Substantial reduction in single sympathetic nerve firing after renal denervation in patients with resistant hypertension. Hypertension 61:457–464CrossRef
7.
Grassi G, Seravalle G, Brambilla G, Trabattoni D, Cuspidi C, Corso R et al (2015) Blood pressure responses to renal denervation precede and are independent of the sympathetic and baroreflex effects. Hypertension 65:1209–1216CrossRef
8.
Ukena C, Mahfoud F, Spies A, Kindermann I, Linz D, Cremers B et al (2013) Effects of renal sympathetic denervation on heart rate and atrioventricular conduction in patients with resistant hypertension. Int J Cardiol 167:2846–2851CrossRef
9.
Böhm M, Mahfoud F, Townsend RR, Kandzari DE, Pocock S, Ukena C et al (2019) Ambulatory heart rate reduction after catheter-based renal denervation in hypertensive patients not receiving anti-hypertensive medications: data from SPYRAL HTN-OFF MED, a randomized, sham-controlled, proof-of-concept trial. Eur Heart J 40:743–751CrossRef
10.
Linz D, Mahfoud F, Schotten U, Ukena C, Hohl M, Neuberger HR et al (2013) Renal sympathetic denervation provides ventricular rate control but does not prevent atrial electrical remodeling during atrial fibrillation. Hypertension 61:225–231CrossRef
11.
Tsioufis C, Papademetriou V, Tsiachris D, Dimitriadis K, Kasiakogias A, Kordalis A et al (2014) Drug-resistant hypertensive patients responding to multielectrode renal denervation exhibit improved heart rate dynamics and reduced arrhythmia burden. J Hum Hypertens 28:587–593CrossRef
12.
Ukena C, Bauer A, Mahfoud F, Schreieck J, Neuberger HR, Eick C et al (2012) Renal sympathetic denervation for treatment of electrical storm: first-in-man experience. Clin Res Cardiol 101:63–67CrossRef
13.
Mahfoud F, Schlaich M, Kindermann I, Ukena C, Cremers B, Brandt MC et al (2011) Effect of renal sympathetic denervation on glucose metabolism in patients with resistant hypertension: a pilot study. Circulation 123:1940–1946CrossRef
14.
Heart rate variability (1996) Standards of measurement, physiological interpretation, and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Eur Heart J 17:354–381CrossRef
15.
Townsend RR, Mahfoud F, Kandzari DE, Kario K, Pocock S, Weber MA et al (2017) Catheter-based renal denervation in patients with uncontrolled hypertension in the absence of antihypertensive medications (SPYRAL HTN-OFF MED): a randomised, sham-controlled, proof-of-concept trial. Lancet 390:2160–2170CrossRef
16.
Azizi M, Schmieder RE, Mahfoud F, Weber MA, Daemen J, Davies J et al (2018) Endovascular ultrasound renal denervation to treat hypertension (RADIANCE-HTN SOLO): a multicentre, international, single-blind, randomised, sham-controlled trial. Lancet 391:2335–2345CrossRef
17.
Kandzari DE, Böhm M, Mahfoud F, Townsend RR, Weber MA, Pocock S et al (2018) Effect of renal denervation on blood pressure in the presence of antihypertensive drugs: 6-month efficacy and safety results from the SPYRAL HTN-ON MED proof-of-concept randomised trial. Lancet 391:2346–2355CrossRef
18.
Mahfoud F, Böhm M, Azizi M, Pathak A, Durand Zaleski I, Ewen S et al (2015) Proceedings from the European clinical consensus conference for renal denervation: considerations on future clinical trial design. Eur Heart J 36:2219–2227CrossRef
19.
Lüscher TF, Mahfoud F (2014) Renal nerve ablation after SYMPLICITY HTN-3: confused at the higher level? Eur Heart. J 35:1706–1711
20.
Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M et al (2018) ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J 39:3021–3104CrossRef
21.
Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS et al (2016) ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 37:2129–2200CrossRef
22.
Levy MN, Zieske H (1969) Autonomic control of cardiac pacemaker activity and atrioventricular transmission. J Appl Physiol 27:465–470CrossRef
23.
Böhm M, Ukena C, Ewen S, Linz D, Zivanovic I, Hoppe U et al (2016) Renal denervation reduces office and ambulatory heart rate in patients with uncontrolled hypertension: 12-month outcomes from the global SYMPLICITY registry. J Hypertens 34:2480–2486CrossRef
24.
Kannel WB, Wolf PA, Benjamin EJ, Levy D (1998) Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol 82:2N–9NCrossRef
25.
Schneider MP, Hua TA, Bohm M, Wachtell K, Kjeldsen SE, Schmieder RE (2010) Prevention of atrial fibrillation by Renin-Angiotensin system inhibition a meta-analysis. J Am Coll Cardiol 55:2299–2307CrossRef
26.
Iwasaki YK, Nishida K, Kato T, Nattel S (2011) Atrial fibrillation pathophysiology: implications for management. Circulation 124:2264–2274CrossRef
27.
Binici Z, Intzilakis T, Nielsen OW, Kober L, Sajadieh A (2010) Excessive supraventricular ectopic activity and increased risk of atrial fibrillation and stroke. Circulation 121:1904–1911CrossRef
28.
Larsen BS, Kumarathurai P, Falkenberg J, Nielsen OW, Sajadieh A (2015) Excessive Atrial Ectopy and Short Atrial Runs Increase the Risk of Stroke Beyond Incident Atrial Fibrillation. J Am Coll Cardiol 66:232–241CrossRef
29.
Pokushalov E, Romanov A, Corbucci G, Artyomenko S, Baranova V, Turov A et al (2012) A randomized comparison of pulmonary vein isolation with versus without concomitant renal artery denervation in patients with refractory symptomatic atrial fibrillation and resistant hypertension. J Am Coll Cardiol 60:1163–1170CrossRef
30.
Pokushalov E, Romanov A, Katritsis DG, Artyomenko S, Bayramova S, Losik D et al (2014) Renal denervation for improving outcomes of catheter ablation in patients with atrial fibrillation and hypertension: early experience. Heart Rhythm 11:1131–1138CrossRef
31.
Romanov A, Pokushalov E, Ponomarev D, Strelnikov A, Shabanov V, Losik D, et al (2017) Pulmonary vein isolation with concomitant renal artery denervation is associated with reduction in both arterial blood pressure and atrial fibrillation burden: data from implantable cardiac monitor. Cardiovasc Therap 35.
32.
Kiuchi MG, Chen S, Hoye NA, Purerfellner H (2018) Pulmonary vein isolation combined with spironolactone or renal sympathetic denervation in patients with chronic kidney disease, uncontrolled hypertension, paroxysmal atrial fibrillation, and a pacemaker. J Interv Card Electrophysiol 51:51–59CrossRef
33.
Feyz L, Theuns DA, Bhagwandien R, Strachinaru M, Kardys I, Van Mieghem NM et al (2019) Atrial fibrillation reduction by renal sympathetic denervation: 12 months' results of the AFFORD study. Clin Res Cardiol 108:634–642CrossRef
34.
de Jong MR, Hoogerwaard AF, Adiyaman A, Smit JJJ, Ramdat Misier AR, Heeg JE et al (2018) Treatment of atrial fibrillation in patients with enhanced sympathetic tone by pulmonary vein isolation or pulmonary vein isolation and renal artery denervation: clinical background and study design : The ASAF trial: ablation of sympathetic atrial fibrillation. Clin Res Cardiol 107:539–547CrossRef
35.
Sassi R, Cerutti S, Lombardi F, Malik M, Huikuri HV, Peng CK et al (2015) Advances in heart rate variability signal analysis: joint position statement by the e-Cardiology ESC Working Group and the European Heart Rhythm Association co-endorsed by the Asia Pacific Heart Rhythm Society. Europace 17:1341–1353CrossRef
36.
Peters CD, Mathiassen ON, Vase H, Bech Norgaard J, Christensen KL, Schroeder AP et al (2017) The effect of renal denervation on arterial stiffness, central blood pressure and heart rate variability in treatment resistant essential hypertension: a substudy of a randomized sham-controlled double-blinded trial (the ReSET trial). Blood Press 26:366–380CrossRef
37.
Verloop WL, Spiering W, Vink EE, Beeftink MM, Blankestijn PJ, Doevendans PA et al (2015) Denervation of the renal arteries in metabolic syndrome: the DREAMS-study. Hypertension 65:751–757CrossRef
38.
Hoogerwaard AF, de Jong MR, Adiyaman A, Smit JJJ, Delnoy P, Heeg JE et al (2019) Renal sympathetic denervation induces changes in heart rate variability and is associated with a lower sympathetic tone. Clin Res Cardiol 108:22–30CrossRef
39.
Tzafriri AR, Mahfoud F, Keating JH, Markham PM, Spognardi A, Wong G et al (2014) Innervation patterns may limit response to endovascular renal denervation. J Am Coll Cardiol 64:1079–1087CrossRef
40.
Mahfoud F, Tunev S, Ewen S, Cremers B, Ruwart J, Schulz-Jander D et al (2015) Impact of lesion placement on efficacy and safety of catheter-based radiofrequency renal denervation. J Am Coll Cardiol 66:1766–1775CrossRef
Metadata
Title
Effects of renal denervation on 24-h heart rate and heart rate variability in resistant hypertension
Authors
Christian Ukena
Tobias Seidel
Konstantinos Rizas
Davide Scarsi
Dominic Millenaar
Sebastian Ewen
Axel Bauer
Felix Mahfoud
Michael Böhm
Publication date
01-05-2020
Publisher
Springer Berlin Heidelberg
Published in
Clinical Research in Cardiology / Issue 5/2020
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI
https://doi.org/10.1007/s00392-019-01543-6

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