Abstract
Aims: Renal denervation using the point-by-point application of radiofrequency (RF) energy delivered by the firstgeneration Symplicity system is effective in lowering office blood pressure however it is time-consuming. The Vessix Renal Denervation System with eight balloon-mounted bipolar electrodes shortens and simplifies the procedure. This has been the first in-human case examining the efficiency of reducing blood pressure and also the effect of RF energy in case of renal denervation on the normal functioning of pacemaker and the tolerability of the procedure in case of a patient living with pacemaker. Materials and methods: The diabetic patient with a coronary artery disease had a baseline office systolic blood pressure ≥ 150 mmHg and took four antihypertensive medications. She had a Biotronik Talos S pacemaker with a unipolar Biotronik PX 60 UP lead because of sick sinus syndrome however she was not dependent on pacemaker. We applied 30 sec. long RF treatments in the renal artery two times. Results: The patients baseline systolic BP was 185 mmHg which reduced by 30 mmHg immediately after the denervation. The lowering of blood pressure was permanent during the 24-hour and four-months supervisions, despite the fact that we carried out the intervention only on one side. The radiofrequency energy did not have an impact on the normal functioning of the pacemaker during and after the intervention. It did cause less physical and psychological burden for the patient than a longer procedure.
Highlights
It occurs that in spite of treating the patients with multiply combined antihypertensive medications, the blood pressure does not decrease to the normal level steadily
In this article we present a case the novelty of which, beside the hybrid therapy, is the experience gained concerning the effect of RF denervation of renal artery on the pacemaker functions
The 68-year-old woman’s case history is the following: she has noninsulin dependent diabetes mellitus (NIDDM), coronary artery disease treated with a drug eluting stent (DES) implantation (2013) in her left anterior descendens (LAD) coronary
Summary
It occurs that in spite of treating the patients with multiply combined antihypertensive medications, the blood pressure does not decrease to the normal level steadily. These patients, after excluding the possibility of secondary hypertension, belong to the group of therapy-resistant hypertension. In practice the treatment of these cases was not possible so far, they were exposed to the danger of stroke, heart attack, or renal complications For this group of patients renal denervation gives a chance to maintain normal blood pressure by further applying of drugs [1,2]. No article has been published yet about the experience in connection with renal denervation with balloon catheter in case of a patient living with pacemaker
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