Emerging Role of Renal Sympathetic Denervation as an Adjunct Therapy to Atrial Fibrillation Ablation

Figures

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  Fig. 1.. Abdominal aortography with a pigtail catheter to identify the renal artery. A pigtail catheter is usually positioned at the vertebra level T1-2 to perform an aortography with a power injector to identify the orifice of bilateral renal arteries and their branches.

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  Fig. 2.. Selective angiography of the right (left panel) and left (right panel) renal artery. This step can be performed with various types of diagnostic catheter (LIMA catheter, MP catheter, or RDC catheter). LIMA, left interval mammary; MP, multi-purpose; RDC, renal double curve.

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  Fig. 3.. Fast Anatomical Map of bilateral renal arteries with ablation’s lesion tags performed by standard unipolar ablation catheter on a three-dimensional anatomical map (CARTO3 mapping system). AP, anteroposterior; PA, posteroanterior; LAO, left anterior oblique; RAO, right anterior oblique; LL, left lateral; RL, right lateral; INF, inferior; SUP, superior.

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  Fig. 4.. Renal denervation performed with a multipolar ablation catheter (Medtronic™ Symplicity spiral catheter) that was advanced inside the distal branch of the renal artery. Kiuchi et al. [46]; with permission (Fig. 1A in original).

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  Fig. 5.. Partially-unfilled renal parenchyma on renal angiogram suggesting presence of the accessory renal artery (Courtesy image from intermountain medical imaging, Boise, Idaho as a part of Healthwise medical review board). References (website): https://www.northshore.org/healthresources/encyclopedia/encyclopedia.aspx?DocumentHwid=zm6032.

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  Fig. 6.. Medtronic Symplicity Spyral renal denervation system. A quadripolar catheter with a distal self-expanding array that can be advanced over a 0.014 guidewire. Real-time responsive algorithm on the machine allows for simultaneous ablation of 4-quadrant of the renal artery. Automatically-adjusted power delivery on each electrode is achieved with a real-time impedance and temperature feedback. An individual electrode can be deselected in the unsuitable location for the ablation [Courtesy image from the brochure of Medtronic Symplicity Spyral renal denervation system]. With courtesy from Medtronic.

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  Fig. 7.. Boston Scientific’s Vessix renal denervation system. Over-the-wire angioplasty balloon catheter system (balloon diameters of 4, 5, 6, 7 mm) with thermistors and electrical gold contact on the exterior part. This system uses a bipolar RF energy. Simultaneous RF energy delivery of all electrodes with automatic deactivation on non-contact electrode. With courtesy from Boston Scientific. RF, radiofrequency.