Potential role of renal sympathetic denervation for the treatment of cardiac arrhythmias

The autonomic nervous system (ANS) has a pivotal role in the pathogenesis and maintenance of atrial and ventricular arrhythmias. Catheter-based renal denervation (RDN) is associated with a reduction of central sympathetic activity, muscle sympathetic nerve activity, and blood pressure in resistant hypertension. As renal afferent nerves are regulators of central sympathetic tone, RDN opens the possibility to modulate sympathetic activity, but without affecting peripheral chemoreceptors and mechanoreceptors in the heart and other organs. RDN was shown to reduce heart rate in humans and to reduce inducibility of atrial fibrillation (AF) as well as ventricular rate during AF in experimental studies. First evidence indicates that pulmonary vein isolation in combination with RDN increases the rate of AF freedom in patients with resistant hypertension. Furthermore, RDN may have a beneficial impact on ventricular arrhythmia, in particular in patients with coronary artery disease or heart failure.