RENAL DENERVATION AS AN ADJUNCTIVE THERAPY TO CARDIAC SYMPATHETIC DENERVATION FOR ABLATION REFRACTORY VENTRICULAR TACHYCARDIA

Abstract Background Autonomic modulation is finding an increasing role in the treatment of ventricular arrhythmias. Renal denervation (RDN) has been described as a treatment modality for refractory ventricular tachycardia (VT) in case series. Objective To evaluate RDN as an adjunctive therapy to cardiac sympathetic denervation (CSD) for ablation refractory VT. Methods Patients who underwent RDN after radiofrequency ablation and CSD procedures at our center from 2012 to 2019 were evaluated. Results Ten patients underwent RDN after CSD (9 bilateral, 1 left-sided only) with median follow-up of 23 months. Mean age was 59.9 ± 10.4 years and 90% were men. All had cardiomyopathy with average ejection fraction 33 ± 11% (20% ischemic). 4 (40%) underwent CSD during the same hospitalization as the RDN. Patients who underwent RDN as adjunctive therapy to CSD had a decrease in all ICD therapies (shocks + ATP) from 29.5 ± 25.2 to 7.1 ± 10.1 comparing 6 months prior to RDN to 6 months post-RDN (p=0.028). ICD shocks were significantly decreased from 7.0 ± 6.1 to 1.7 ± 2.5 comparing 6 months prior to RDN to 6 months post-RDN (p=0.026). This benefit was driven by a decrease in therapies for 6 patients that had a staged procedure, not performed during the same hospitalization (28.5 ± 24.3 to 1.0 ±1.2, p=0.043). Conclusion RDN demonstrates potential benefit when VT recurs after RFA and CSD. The benefit is seen in patients who undergo a staged procedure. The need for acute RDN after CSD portends a poor prognosis.