Jackson Nicholas, Gizurarson Sigfús, Azam Mohammed Ali, King Benjamin, Ramadeen Andrew, Zamiri Nima, Porta-Sánchez Andreu, Al-Hesayen Abdul, Graham John, Kusha Marjan, Massé Stéphane, Lai Patrick F H, Parker John, John Rohan, Kiehl Tim-Rasmus, Nair Govind Krishna Kumar, Dorian Paul, Nanthakumar Kumaraswamy
From the Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology (N.J., S.G., M.A.A., B.K., N.Z., A.P.-S., M.K., S.M., P.F.H.L., G.K.K.N., K.N.) and Department of Pathology (R.J., T.-R.K.), University Health Network, Toronto, Ontario, Canada; St Michael's Hospital, Toronto, Ontario, Canada (A.R., A.A.-H., J.G., P.D.); University of Newcastle, Australia (N.J.); and Mount Sinai Hospital, Toronto, Ontario, Canada (J.P.).
Circ Cardiovasc Interv. 2017 Mar;10(3):e004172. doi: 10.1161/CIRCINTERVENTIONS.116.004172.
The therapeutic potential of renal denervation (RDN) for arrhythmias has not been fully explored. Detailed mechanistic evaluation is in order. The objective of the present study was to determine the antiarrhythmic potential of RDN in a postinfarct animal model and to determine whether any benefits relate to RDN-induced reduction of sympathetic effectors on the myocardium.
Pigs implanted with single-chamber implantable cardioverter defibrillators to record ventricular arrhythmias (VAs) were subjected to percutaneous coronary occlusion to induce myocardial infarction. Two weeks later, a sham or real RDN treatment was performed bilaterally using the St Jude EnligHTN basket catheter. Parameters of ventricular remodeling and modulation of cardio-renal sympathetic axis were monitored for 3 weeks after myocardial infarction. Histological analysis of renal arteries yielded a mean neurofilament score of healthy nerves that was significantly lower in the real RDN group than in sham controls; damaged nerves were found only in the real RDN group. There was a 100% reduction in the rate of spontaneous VAs after real RDN and a 75% increase in the rate of spontaneous VAs after sham RDN (=0.03). In the infarcted myocardium, presence of sympathetic nerves and tissue abundance of neuropeptide-Y, an indicator of sympathetic nerve activities, were significantly lower in the RDN group. Peak and mean sinus tachycardia rates were significantly reduced after RDN.
RDN in the infarcted pig model leads to reduction of postinfarction VAs and myocardial sympathetic effectors. This may form the basis for a potential therapeutic role of RDN in postinfarct VAs.
肾去神经支配术（RDN）治疗心律失常的潜力尚未得到充分探索。需要进行详细的机制评估。本研究的目的是确定RDN在心肌梗死后动物模型中的抗心律失常潜力，并确定其益处是否与RDN诱导的心肌交感效应器减少有关。
植入单腔植入式心脏复律除颤器以记录室性心律失常（VA）的猪接受经皮冠状动脉闭塞以诱导心肌梗死。两周后，使用圣犹达EnligHTN篮状导管双侧进行假手术或真正的RDN治疗。在心肌梗死后3周监测心室重构参数和心肾交感轴的调节。肾动脉的组织学分析显示，真正的RDN组健康神经的平均神经丝评分显著低于假手术对照组；仅在真正的RDN组中发现受损神经。真正的RDN后自发性VA发生率降低了100%，假手术RDN后自发性VA发生率增加了75%（P=0.03）。在梗死心肌中，RDN组交感神经的存在和作为交感神经活动指标的神经肽Y的组织丰度显著降低。RDN后窦性心动过速的峰值和平均速率显著降低。
梗死猪模型中的RDN可导致心肌梗死后VA和心肌交感效应器减少。这可能构成RDN在心肌梗死后VA中潜在治疗作用的基础。
