Versaci Francesco, Sciarretta Sebastiano, Scappaticci Massimiliano, Di Pietro Riccardo, Calcagno Simone, Del Prete Armando, Gaspardone Carlo, Biondi Zoccai Giuseppe
UOC UTIC, Emodinamica e Cardiologia, Ospedale Santa Maria Goretti, Latina 04100, Italia.
Dipartimento di Scienze Medico-Chirurgiche e Biotecnologie, Università di Roma La Sapienza, Latina, 04100, Italia.
Eur Heart J Suppl. 2021 Oct 8;23(Suppl E):E177-E183. doi: 10.1093/eurheartj/suab117. eCollection 2021 Oct.
Renal denervation (RDN) is a therapeutic strategy for patients with uncontrolled arterial hypertension characterized by considerable fluctuations during its progression. After initial strong enthusiasm, the procedure came to an abrupt halt following the publication of the Symplicity HTN-3 study results. The results of recently published studies highlight the reduction in blood pressure values after RDN and justify the inclusion in the Guidelines of new recommendations for the use of RDN in clinical practice, in selected patients. Additionally, RDN findings are summarized in view of other potential indications such as atrial fibrillation. Six prospective, randomized studies are presented that evaluated RDN as an adjunct therapy to pulmonary vein isolation for the treatment of atrial fibrillation. In five studies, patients had uncontrolled hypertension despite therapy with three antihypertensive drugs. The analysis of these studies showed that RDN reduced the recurrence of atrial fibrillation (AF) by 57% compared to patients with pulmonary vein isolation (PVI) only. Modulation of the autonomic nervous system by RDN has been shown not only to reduce blood pressure but also to have an antiarrhythmic effect in symptomatic AF patients when the strategy is combined with PVI, thus opening up new therapeutic scenarios.
肾去神经支配术（RDN）是一种针对难治性动脉高血压患者的治疗策略，其病程中血压波动较大。在最初的高度热情之后，随着Symplicity HTN - 3研究结果的公布，该手术突然停止。最近发表的研究结果突出了RDN术后血压值的降低，并证明在临床实践中，对于选定患者，将RDN的新使用建议纳入指南是合理的。此外，鉴于心房颤动等其他潜在适应症，对RDN的研究结果进行了总结。本文介绍了六项前瞻性随机研究，这些研究评估了RDN作为肺静脉隔离辅助治疗心房颤动的效果。在五项研究中，尽管使用了三种抗高血压药物治疗，患者仍患有难治性高血压。对这些研究的分析表明，与仅接受肺静脉隔离（PVI）的患者相比，RDN使心房颤动（AF）的复发率降低了57%。当该策略与PVI联合使用时，RDN对自主神经系统的调节不仅能降低血压，还对有症状的AF患者具有抗心律失常作用，从而开辟了新的治疗前景。
