Modulation of renal sympathetic innervation: recent insights beyond blood pressure control
Abstract Renal afferent and efferent sympathetic nerves are involved in the regulation of blood pressure and have a pathophysiological role in hypertension. Additionally, several conditions that frequently coexist with hypertension, such as heart failure, obstructive sleep apnea, atri...
| Main Authors: | , , , , , , , |
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| Other Authors: | |
| Format: | Article |
| Language: | English |
| Published: |
Springer Berlin Heidelberg
2021
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| Online Access: | https://hdl.handle.net/1721.1/131371 |
| _version_ | 1826195753593208832 |
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| author | Linz, Dominik Hohl, Mathias Elliott, Adrian D Lau, Dennis H Mahfoud, Felix Esler, Murray D Sanders, Prashanthan Böhm, Michael |
| author2 | Massachusetts Institute of Technology. Institute for Medical Engineering & Science |
| author_facet | Massachusetts Institute of Technology. Institute for Medical Engineering & Science Linz, Dominik Hohl, Mathias Elliott, Adrian D Lau, Dennis H Mahfoud, Felix Esler, Murray D Sanders, Prashanthan Böhm, Michael |
| author_sort | Linz, Dominik |
| collection | MIT |
| description | Abstract
Renal afferent and efferent sympathetic nerves are involved in the regulation of blood pressure and have a pathophysiological role in hypertension. Additionally, several conditions that frequently coexist with hypertension, such as heart failure, obstructive sleep apnea, atrial fibrillation, renal dysfunction, and metabolic syndrome, demonstrate enhanced sympathetic activity. Renal denervation (RDN) is an approach to reduce renal and whole body sympathetic activation. Experimental models indicate that RDN has the potential to lower blood pressure and prevent cardio-renal remodeling in chronic diseases associated with enhanced sympathetic activation. Studies have shown that RDN can reduce blood pressure in drug-naïve hypertensive patients and in hypertensive patients under drug treatment. Beyond its effects on blood pressure, sympathetic modulation by RDN has been shown to have profound effects on cardiac electrophysiology and cardiac arrhythmogenesis. RDN can display anti-arrhythmic effects in a variety of animal models for atrial fibrillation and ventricular arrhythmias. The first non-randomized studies demonstrate that RDN may promote the maintenance of sinus rhythm following catheter ablation in patients with atrial fibrillation. Registry data point towards a beneficial effect of RDN to prevent ventricular arrhythmias in patients with heart failure and electrical storm. Further large randomized placebo-controlled trials are needed to confirm the antihypertensive and anti-arrhythmic effects of RDN. Here, we will review the current literature on anti-arrhythmic effects of RDN with the focus on atrial fibrillation and ventricular arrhythmias. We will discuss new insights from preclinical and clinical mechanistic studies and possible clinical implications of RDN. |
| first_indexed | 2024-09-23T10:14:54Z |
| format | Article |
| id | mit-1721.1/131371 |
| institution | Massachusetts Institute of Technology |
| language | English |
| last_indexed | 2024-09-23T10:14:54Z |
| publishDate | 2021 |
| publisher | Springer Berlin Heidelberg |
| record_format | dspace |
| spelling | mit-1721.1/1313712024-03-19T13:55:57Z Modulation of renal sympathetic innervation: recent insights beyond blood pressure control Linz, Dominik Hohl, Mathias Elliott, Adrian D Lau, Dennis H Mahfoud, Felix Esler, Murray D Sanders, Prashanthan Böhm, Michael Massachusetts Institute of Technology. Institute for Medical Engineering & Science Abstract Renal afferent and efferent sympathetic nerves are involved in the regulation of blood pressure and have a pathophysiological role in hypertension. Additionally, several conditions that frequently coexist with hypertension, such as heart failure, obstructive sleep apnea, atrial fibrillation, renal dysfunction, and metabolic syndrome, demonstrate enhanced sympathetic activity. Renal denervation (RDN) is an approach to reduce renal and whole body sympathetic activation. Experimental models indicate that RDN has the potential to lower blood pressure and prevent cardio-renal remodeling in chronic diseases associated with enhanced sympathetic activation. Studies have shown that RDN can reduce blood pressure in drug-naïve hypertensive patients and in hypertensive patients under drug treatment. Beyond its effects on blood pressure, sympathetic modulation by RDN has been shown to have profound effects on cardiac electrophysiology and cardiac arrhythmogenesis. RDN can display anti-arrhythmic effects in a variety of animal models for atrial fibrillation and ventricular arrhythmias. The first non-randomized studies demonstrate that RDN may promote the maintenance of sinus rhythm following catheter ablation in patients with atrial fibrillation. Registry data point towards a beneficial effect of RDN to prevent ventricular arrhythmias in patients with heart failure and electrical storm. Further large randomized placebo-controlled trials are needed to confirm the antihypertensive and anti-arrhythmic effects of RDN. Here, we will review the current literature on anti-arrhythmic effects of RDN with the focus on atrial fibrillation and ventricular arrhythmias. We will discuss new insights from preclinical and clinical mechanistic studies and possible clinical implications of RDN. 2021-09-20T17:16:46Z 2021-09-20T17:16:46Z 2018-02-10 2020-09-24T21:03:20Z Article http://purl.org/eprint/type/JournalArticle https://hdl.handle.net/1721.1/131371 en https://doi.org/10.1007/s10286-018-0508-0 Article is made available in accordance with the publisher's policy and may be subject to US copyright law. Please refer to the publisher's site for terms of use. Springer-Verlag GmbH Germany, part of Springer Nature application/pdf Springer Berlin Heidelberg Springer Berlin Heidelberg |
| spellingShingle | Linz, Dominik Hohl, Mathias Elliott, Adrian D Lau, Dennis H Mahfoud, Felix Esler, Murray D Sanders, Prashanthan Böhm, Michael Modulation of renal sympathetic innervation: recent insights beyond blood pressure control |
| title | Modulation of renal sympathetic innervation: recent insights beyond blood pressure control |
| title_full | Modulation of renal sympathetic innervation: recent insights beyond blood pressure control |
| title_fullStr | Modulation of renal sympathetic innervation: recent insights beyond blood pressure control |
| title_full_unstemmed | Modulation of renal sympathetic innervation: recent insights beyond blood pressure control |
| title_short | Modulation of renal sympathetic innervation: recent insights beyond blood pressure control |
| title_sort | modulation of renal sympathetic innervation recent insights beyond blood pressure control |
| url | https://hdl.handle.net/1721.1/131371 |
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