Renal sympathetic denervation guided by renal nerve stimulation to treat ventricular arrhythmia in CKD patients with ICD

// Márcio Galindo Kiuchi 1, 3 , Shaojie Chen 2, 3 , Luis Marcelo Rodrigues Paz 1 and Helmut Pürerfellner 3 1 Department of Medicine, Division of Artificial Cardiac Stimulation, Hospital e Clínica São Gonçalo, São Gonçalo, Rio de Janeiro, Brazil 2 Department of Cardiology, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China 3 Department of Cardiology, Elisabethinen University Teaching Hospital Linz, Linz, Austria Correspondence to: Márcio Galindo Kiuchi, email: marciokiuchi@gmail.com Keywords: ventricular arrhythmias, anti-tachycardia therapy pacing, automatic cardioverter-defibrillator, chronic renal disease, renal sympathetic denervation Received: February 01, 2017      Accepted: March 01, 2017      Published: March 16, 2017 ABSTRACT Chronic kidney disease (CKD) patients on stage 4 present greater risk rates for malignant ventricular arrhythmia events. This study examined patients with CKD in stages 1, 2, 3 and 4, left ventricular dysfunction and automatic implantable cardioverter-defibrillator (ICD). Our goal was to record the appropriate therapies, “Anti-tachycardia Therapy Pacing” (ATP) and shock events during the 18 months of follow-up and compare the incidence and severity of these at different stages of CKD, mainly in patients with CKD stage 4 underwent renal sympathetic denervation (RSD) guided by renal nerve stimulation (RNS). One hundred and fifteen patients were evaluated once every three months till 18 months of follow-up. The arrhythmic events were assessed at each follow-up visit. Comparing the groups, we can see the number of ATP and shock events recorded by ICD during 18 months of follow-up, and differences in the number of therapeutic events between the various stages of CKD. The hazard ratio (HR), 95% confidence interval (CI) and P value for ATP and shock events between all the CKD stages were evaluated by the log-rank/Mantel-Haenszel test. At the 18 th month of follow-up, 75% of patients with CKD stage 4 received ATP, and 70% were treated with shock while only 20% of the subjects with CKD stage 4 that were submitted to RSD received ATP and 20% were treated with shock, P<0.0001 and P=0.0002, respectively. In our study, a decline occurred in the incidence of arrhythmias, and therefore, appropriate ICD therapies in advanced stages of CKD, reducing the risk rates for these events in patients with CKD on stage 4 after RSD guided by RNS in comparison to the other CKD stages. Our results suggest that RSD can control the higher incidence of malignant arrhythmias in advanced CKD stages.