SAFETY OF RENAL SYMPATHETIC DENERVATION FOLLOWING RECENT MYOCARDIAL INFARCTION

Abstract

BackgroundThe post myocardial infarction (AMI) state is associated with increase in sympathetic activity. Renal sympathetic denervation (RDN) has been shown to reduce central sympathetic outflow. Studies are ongoing in patients with stable heart failure, but no study has demonstrated safety of RDN following a recent myocardial infarction.MethodsFifteen pigs were randomised to real AMI&real RDN (6 pigs), real AMI&sham RDN (6 pigs) and to sham AMI&sham RDN (3 pigs). Infarcts were created by percutaneous occlusion of the mid to distal LAD and 2 weeks later RDN was performed bilaterally with the St Jude EnligHTN® basket catheter. Amubulatory sinus rates, ventricular remodelling parameters and urinary sodium were measured throughout the 3-week duration of the study.ResultsThe mean sinus heart rates in the real AMI&sham RDN group went from 224+/-4 bpm to 234+/-9bpm and in the real AMI&real RDN group they went from 225+/-15bpm to 219+/-11bpm following RDN (p=0.04). The peak sinus rhythm rate for each pig was also significantly less in the real AMI&real RDN group (261+/-15bpm to 276+/-28bpm in the sham RDN group compared with 271+/-22bpm to 254+/-30bpm in the real RDN group, p=0.03). The mean LVEF went from 58+/-4% pre infarct to 54+/-4% (p=0.28) post infarct and the mean LVEDV increased from 42+/-7mls3 to 49+/-8mls3 (p=0.02) in the groups where a real AMI was performed. Pairwise comparison showed no significant difference between the real AMI&sham RDN group and the real AMI&real RDN group for LVEF (p=0.28) or LVEDV (p=0.44). Mean urinary sodium levels were 55+/-14mmol/L in the real AMI&sham RDN group and were 62+/-14mmol/L in the real AMI&real RDN group (p=0.45).ConclusionSt. Jude Medical BackgroundThe post myocardial infarction (AMI) state is associated with increase in sympathetic activity. Renal sympathetic denervation (RDN) has been shown to reduce central sympathetic outflow. Studies are ongoing in patients with stable heart failure, but no study has demonstrated safety of RDN following a recent myocardial infarction. The post myocardial infarction (AMI) state is associated with increase in sympathetic activity. Renal sympathetic denervation (RDN) has been shown to reduce central sympathetic outflow. Studies are ongoing in patients with stable heart failure, but no study has demonstrated safety of RDN following a recent myocardial infarction. MethodsFifteen pigs were randomised to real AMI&real RDN (6 pigs), real AMI&sham RDN (6 pigs) and to sham AMI&sham RDN (3 pigs). Infarcts were created by percutaneous occlusion of the mid to distal LAD and 2 weeks later RDN was performed bilaterally with the St Jude EnligHTN® basket catheter. Amubulatory sinus rates, ventricular remodelling parameters and urinary sodium were measured throughout the 3-week duration of the study. Fifteen pigs were randomised to real AMI&real RDN (6 pigs), real AMI&sham RDN (6 pigs) and to sham AMI&sham RDN (3 pigs). Infarcts were created by percutaneous occlusion of the mid to distal LAD and 2 weeks later RDN was performed bilaterally with the St Jude EnligHTN® basket catheter. Amubulatory sinus rates, ventricular remodelling parameters and urinary sodium were measured throughout the 3-week duration of the study. ResultsThe mean sinus heart rates in the real AMI&sham RDN group went from 224+/-4 bpm to 234+/-9bpm and in the real AMI&real RDN group they went from 225+/-15bpm to 219+/-11bpm following RDN (p=0.04). The peak sinus rhythm rate for each pig was also significantly less in the real AMI&real RDN group (261+/-15bpm to 276+/-28bpm in the sham RDN group compared with 271+/-22bpm to 254+/-30bpm in the real RDN group, p=0.03). The mean LVEF went from 58+/-4% pre infarct to 54+/-4% (p=0.28) post infarct and the mean LVEDV increased from 42+/-7mls3 to 49+/-8mls3 (p=0.02) in the groups where a real AMI was performed. Pairwise comparison showed no significant difference between the real AMI&sham RDN group and the real AMI&real RDN group for LVEF (p=0.28) or LVEDV (p=0.44). Mean urinary sodium levels were 55+/-14mmol/L in the real AMI&sham RDN group and were 62+/-14mmol/L in the real AMI&real RDN group (p=0.45). The mean sinus heart rates in the real AMI&sham RDN group went from 224+/-4 bpm to 234+/-9bpm and in the real AMI&real RDN group they went from 225+/-15bpm to 219+/-11bpm following RDN (p=0.04). The peak sinus rhythm rate for each pig was also significantly less in the real AMI&real RDN group (261+/-15bpm to 276+/-28bpm in the sham RDN group compared with 271+/-22bpm to 254+/-30bpm in the real RDN group, p=0.03). The mean LVEF went from 58+/-4% pre infarct to 54+/-4% (p=0.28) post infarct and the mean LVEDV increased from 42+/-7mls3 to 49+/-8mls3 (p=0.02) in the groups where a real AMI was performed. Pairwise comparison showed no significant difference between the real AMI&sham RDN group and the real AMI&real RDN group for LVEF (p=0.28) or LVEDV (p=0.44). Mean urinary sodium levels were 55+/-14mmol/L in the real AMI&sham RDN group and were 62+/-14mmol/L in the real AMI&real RDN group (p=0.45). ConclusionSt. Jude Medical St. Jude Medical