Hawson Joshua, Harmer Jason A, Cowan Mitchell, Virk Sohaib, Campbell Timothy, Bennett Richard G, Anderson Robert D, Kalman Jonathan, Lee Geoffrey, Kumar Saurabh
Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia.
Department of Cardiology, Royal North Shore Hospital, St. Leonards, New South Wales, Australia; Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
JACC Clin Electrophysiol. 2021 Jan;7(1):100-108. doi: 10.1016/j.jacep.2020.07.019. Epub 2020 Sep 30.
The authors performed a systematic review and meta-analysis to determine the efficacy of renal denervation (RDN) in patients with refractory ventricular arrhythmias (VA) or electrical storm (ES).
Although catheter ablation is efficacious for the treatment of structural heart disease ventricular tachycardia (VT), there are proportion of patients who have refractory VT despite multiple procedures. In this setting, novel adjunctive therapies such as renal denervation have been performed.
A systematic review of published data was performed. Studies that evaluated patients undergoing RDN for VA or ES were included. Outcome measures of VA, sudden cardiac death, ES, or device therapy were required. Case reports, editorials, and conference presentations were excluded. Random effects meta-analysis was conducted to explore change or final mean values in the study outcomes.
A total of 328 articles were identified by the literature search. Seven studies met the eligibility criteria and were included in the systematic review, with a total of 121 pooled patients. The weighted mean age was 63.8 ± 13.1 years, ejection fraction 30.5 ± 10.3%, 76% were men, 99% were on a beta blocker, 79% were on amiodarone, 46% had previously undergone catheter ablation, and 8.3% had previously undergone cardiac sympathetic denervation. Meta-analysis demonstrated a significant effect of RDN in reducing implantable cardiac defibrillator therapies, with a standardized mean difference (SMD) of -3.11 (p < 0.001). RDN also reduced the number of VA episodes (SMD -2.13; p < 0.001), antitachycardia pacing episodes (SMD -2.82; p = 0.002), and shocks (SMD -2.82; p = 0.002).
RDN is an effective treatment for refractory VAs and ES, although randomized data are lacking.
作者进行了一项系统评价和荟萃分析，以确定肾去神经支配术（RDN）对难治性室性心律失常（VA）或电风暴（ES）患者的疗效。
尽管导管消融术对结构性心脏病室性心动过速（VT）的治疗有效，但仍有一部分患者尽管接受了多次手术，VT仍难以控制。在这种情况下，已开展了诸如肾去神经支配术等新型辅助治疗。
对已发表的数据进行系统评价。纳入评估接受RDN治疗VA或ES患者的研究。需要有VA、心源性猝死、ES或器械治疗的结局指标。排除病例报告、社论和会议报告。进行随机效应荟萃分析以探讨研究结局中的变化或最终均值。
通过文献检索共识别出328篇文章。七项研究符合纳入标准并被纳入系统评价，共有121例汇总患者。加权平均年龄为63.8±13.1岁，射血分数为30.5±10.3%，76%为男性，99%服用β受体阻滞剂，79%服用胺碘酮，46%曾接受导管消融术，8.3%曾接受心脏交感神经去神经支配术。荟萃分析表明，RDN在减少植入式心脏除颤器治疗方面有显著效果，标准化均值差（SMD）为-3.11（p<0.001）。RDN还减少了VA发作次数（SMD -2.13；p<0.001）、抗心动过速起搏发作次数（SMD -2.82；p = 0.002）和电击次数（SMD -2.82；p = 0.002）。
尽管缺乏随机数据，但RDN是治疗难治性VA和ES的有效方法。
