THE EFFECT OF SYMPATHETIC RENAL DENERVATION ON ARRHYTHMIAS BURDEN IN PATIENTS WITH UNCONTROLLED HYPERTENSION

Abstract

Objective: Increased tone of the autonomic sympathetic nervous system plays a dominant role in the pathophysiology of cardiac arrhythmias. Sympathetic Renal Denervation (RDN) is a minimally invasive, alternative method of treating drug resistant arterial hypertension (HTN) with recent data also showing its positive effect in patients with atrial fibrillation (AF), atrial and ventricular arrhythmias. The aim of this study was to evaluate the effect of RDN on the total arrhythmias burden in patients with uncontrolled HTN. Design and method: The present clinical study is a randomized, single-center study including thirty (30) consecutive patients (> 18 years) with uncontrolled HTN. Patients will be randomized (1: 1) either to RDN (n = 15) or to conventional treatment of HTN with drugs (n = 15) according to the current European guidelines for the treatment of HTN. Patients will receive a 24-hour ECG Holter monitoring upon enrollment. All persistent and non-persistent atrial and ventricular arrhythmias will be recorded. After randomization, patients will be monitored for six months. 24-hour ECG Holter monitoring will also take place at 3 months after the enrollment. Office blood pressure (OBP) measurements as well as a 24-hour ambulatory blood pressure monitoring (ABPM) will be recorded at baseline and 3 months. Results: The primary endpoint of the study is the change in the total arrhythmias ’burden’ from inclusion to 3 months (Number of supraventricular and ventricular arrhythmias, premature atrial and ventricular comlexes). Secondary endpoints will include the change in the symptomatic and asymptomatic ’burden’ of the arrhythmias, the change in the supraventricular and ventricular arrhythmias burden, and the change in the OBP and ABPM from baseline to 3 months. Conclusions: This is the first study in the literature which aims to provide additional evidence for the pleotropic effect of RDN in patients with uncontrolled HTN and the total both symptomatic and asymptomatic atrial and ventricular arrhythmia burden. The relationship between the level of arterial hypertension reduction and arrhythmias will also be studied.