Renal nerve stimulation identifies renal innervation and optimizes the strategy for renal denervation in canine

Figures

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  Fig. 1. Flow-chart of the procedure. A the characteristics of renal autonomic innervation at these sites with different BP responses to RNS were investigated. B the BP changes after radiofrequency ablation at elevated BP response sites and reduced BP response sites were investigated. ER, elevated BP response; RR, reduced BP response; NR, non-response; LERA, low-energy radiofrequency ablation; RSC, renal stimulation control group; ERA, elevated BP response ablation group; RRA, reduced BP response ablation group; RF, radiofrequency

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  Fig. 2. The proportion of efferent sympathetic, afferent sensory and parasympathetic nerve fibers among ERS, RRS and NRS. Renal efferent sympathetic nerves (red, labeled by TH), renal afferent sensory nerves (green, labeled by CGRP) and parasympathetic nerve fibers (red, labeled by nNOS) in one nerve bundle, and cell nuclei (blue, labeled by DAPI) were identified

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  Fig. 3. The correlation Between the BP response to RNS and renal autonomic innervation. A indicated no correlation between SBP changes and proportions of efferent sympathetic nerve; B showed the maximum SBP changes during RNS were correlated with proportions of afferent sensory nerve; C showed the maximum SBP changes during RNS were correlated with proportions of parasympathetic nerve and D showed a significant correlation between SBP changes and the area ratios of afferent sensory and parasympathetic nerve

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  Fig. 4. Representative images of BP response to RNS and trajectories of heart rate and BP changes. A showed the representative image of elevated BP response site, B showed the representative image of reduced BP response site, C showed the representative image of non-response site, D showed the SBP response to RNS during 60-s period, E showed the HR response to RNS during 60-s period

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  Fig. 5. Blood pressure (BP) changes and correlation analysis. A levels of SBP before and 4-week after ablation among the 3 groups. B levels of diastolic blood pressure (DBP) before and 4-week after ablation among the 3 groups. C maximum SBP changes to the stimulation before and immediately after ablation in the RRA and ERA groups. D SBP changes at 4-week follow-up among the 3 groups. E correlation between SBP changes at 4-week follow-up and SBP changes to the stimulation before ablation. F correlation between DBP changes at 4-week follow-up and DBP changes to the stimulation before ablation

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  Fig. 6. Plasma norepinephrine (NE) changes and correlation analysis. A plasma NE levels before and 4 weeks after ablation. B plasma NE changes at 4 weeks after ablation. C correlation between plasma NE changes at 4 weeks and systolic blood pressure (SBP) changes to the stimulation before ablation. D correlation between plasma NE and SBP changes at 4 weeks