Role of Adjuvant Renal Sympathetic Denervation in the Treatment of Ventricular Arrhythmias

Abstract Ventricular arrhythmias are known to result in significant morbidity and mortality rates in patients with both ischemic and non-ischemic dilated cardiomyopathy (DCM). Although catheter ablation has emerged as an adjunct treatment strategy in the management of ventricular arrhythmias, 1-year follow-up data has revealed that ventricular tachycardia (VT)- free survival rate is approximately 50%. Up to now, a few small case series with short- term follow- up have reported reduced VT recurrence following application of renal sympathetic denervation (RSDN) in patients suffering from refractory ventricular arrhythmias. In this study, we aimed to investigate the safety and efficacy of RSDN as an adjunctive therapy to catheter ablation for refractory ventricular arrhythmias (VAs) in patients with DCM. For this purpose, we conducted a retrospective, propensity score- matched cohort study. A total of 32 patients with implantable cardioverter-defibrillators (ICDs) undergoing catheter ablation or both catheter ablation and RSDN for refractory VAs were included in the analysis. Patients were followed- up at a median of 15 months (6- 20 months). Patient groups did not differ regarding the mean number of VT/ VF episodes in the last six months prior to the procedure (35.00± 4.10 in catheter ablation only group vs. 43.00± 5.30 in catheter ablation+ RSDN group, p= 0.23). There was a significant decrease in burden of both VT/ VF and anti-tachycardia pacing (ATP) and shock therapies delivered from ICDs in the patient group that received RSDN as an adjunct therapy (p< 0.05). Mortality rates were similar in two groups (p> 0.05). In conclusion, our findings suggest that adjunctive RSDN is a safe and effective method for reducing the arrhythmic burden in patients with refractory VAs. In the future, it may be performed routinely in patients with ICDs and refractory VAs.