Greater Splanchnic Nerve Ablation in Heart Failure with Preserved Ejection Fraction: a Mini-Narrative Review of Emerging Evidence

Exercise intolerance and volume overload are key symptoms that characterize the complex syndrome called heart failure with preserved ejection fraction (HFpEF). The increased pulmonary capillary wedge pressure (PCWP) also contributes significantly to these symptoms. A promising intervention, greater splanchnic nerve (GSN) ablation, is an approach that alleviates this volume overload by modulating sympathetic tone. This mini-narrative review discusses data from six (6) clinical trials investigating the effects of GSN ablation in HFpEF. These studies focus on procedural safety, hemodynamic outcomes (PCWP), clinical measures (NYHA class, KCCQ score), and adverse events. The trials varied in terms of sample size, patient characteristics, and follow-up durations, with a total of 259 patients. In addition, the outcomes were assessed at 1, 3, 6, and 12 months. The studies report positive outcomes with reductions in PCWP, especially during exercise. The NYHA classes and KCCQ scores were also improved in patients. Exercise capacity was measured by the 6-min walk test, and studies reported notable gains. NT-proBNP levels were also decreased, indicating an improvement in heart failure status. Some trials reported mild procedural complications such as pain and site injection; however, no significant adverse events were reported. GSN ablation presents a therapeutic approach for patients with HFpEF. While short-term benefits are evident, further large-scale randomized trials are necessary to confirm the long-term efficacy and safety of this procedure. In addition, its application in patients with diverse characteristics and comorbidities needs to be investigated and validated before it is incorporated into clinical practice.