Novel use of NavX three-dimensional mapping to guide renal artery denervation

Abstract

Renal artery denervation (RAD) is an effective treatment for resistant hypertension. The Navigation and Visualisation Technology (NavX) system creates three-dimensional (3-D) anatomical maps to guide catheter position and identify ablation sites. This first-in-human study assessed the utility of NavX 3-D mapping for RAD. Consecutive patients who underwent RAD using fluoroscopy alone (control group, n=8) were compared to NavX-guided RAD (NavX group, n=10). Where NavX was utilised, orthogonally located skin patches were applied to the torso for acquisition of 3-D geometry of each renal artery. Baseline clinical characteristics and renal artery anatomy were similar between groups. Median contrast dose was significantly higher in the control versus NavX group (123 ml versus 78 ml, p=0.016). Median radiation dose was significantly higher in the control versus NavX group (166 Gy cm² versus 43 Gy cm², p=0.034). Mean changes in systolic and diastolic BP at three-month follow-up were -22/-9 mmHg and -23/-11 mmHg in the control and NavX group, respectively (p=0.99). Use of NavX mapping as compared to standard renal artery denervation was found to correlate with a significant reduction in contrast load and radiation exposure. This study demonstrates both the feasibility and potential benefits of NavX 3-D mapping to guide renal artery denervation.