Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Kirrberger Str. 1, 66421 Homburg/Saar, Germany.
Clin Res Cardiol. 2012 Jan;101(1):63-7. doi: 10.1007/s00392-011-0365-5. Epub 2011 Sep 29.
Sympathetic activity plays an important role in the pathogenesis of ventricular tachyarrhythmia. Catheter-based renal sympathetic denervation (RDN) is a novel treatment option for patients with resistant hypertension, proved to reduce local and whole-body sympathetic activity.
Two patients with chronic heart failure (CHF) (non-obstructive hypertrophic and dilated cardiomyopathy, NYHA III) suffering from therapy resistant electrical storm underwent therapeutic renal denervation. In both patients, RDN was conducted with agreement of the local ethics committee and after obtaining informed consent.
The patient with hypertrophic cardiomyopathy had recurrent monomorphic ventricular tachycardia despite extensive antiarrhythmic therapy, following repeated endocardial and epicardial electrophysiological ablation attempts to destroy an arrhythmogenic intramural focus in the left ventricle. The second patient, with dilated nonischemic cardiomyopathy, suffered from recurrent episodes of polymorphic ventricular tachycardia and ventricular fibrillation. The patient declined catheter ablation of these tachycardias. In both patients, RDN was performed without procedure-related complications. Following RDN, ventricular tachyarrhythmias were significantly reduced in both patients. Blood pressure and clinical status remained stable during the procedure and follow-up in these patients with CHF.
Our findings suggest that RDN is feasible even in cardiac unstable patients. Randomized controlled trials are urgently needed to study the effects of RD in patients with electrical storm and CHF.
交感神经活动在室性心动过速的发病机制中起重要作用。基于导管的肾脏去交感神经支配（RDN）是一种治疗抵抗性高血压的新方法，已被证明可降低局部和全身交感神经活性。
两名患有慢性心力衰竭（CHF）（非梗阻性肥厚型和扩张型心肌病，NYHA III）的患者，因电风暴而对治疗有抵抗力，接受了治疗性肾去交感神经支配。在这两名患者中，均经当地伦理委员会同意，并在获得知情同意后进行 RDN。
肥厚型心肌病患者尽管进行了广泛的抗心律失常治疗，但仍反复发作单形性室性心动过速，在反复进行心内膜和心外膜电生理消融以破坏左心室的致心律失常壁内焦点后，仍反复发作。第二位患者，患有非缺血性扩张型心肌病，反复发作多形性室性心动过速和心室颤动。该患者拒绝对这些心动过速进行导管消融。在这两名患者中，RDN 均无相关程序并发症。RDN 后，两名患者的室性心动过速均明显减少。在这些患有 CHF 的患者中，RDN 过程中和随访期间血压和临床状况保持稳定。
我们的发现表明，即使在心脏不稳定的患者中，RDN 也是可行的。迫切需要进行随机对照试验来研究 RD 在电风暴和 CHF 患者中的作用。
