Abstract
Transluminal renal sympathetic denervation (RDN) reduces blood pressure (BP) in patients with drug-resistant uncontrolled hypertension. We assessed the effect of RDN on heart rate, supraventricular and ventricular ectopic activity and indexes of heart rate variability in 14 patients with drug-resistant uncontrolled hypertension who were all responders to RDN (defined as a reduction in office systolic BP ⩾10 mm Hg) at baseline and at 1 and 6 months after the procedure using the multielectrode EnligHTN ablation catheter (St Jude Medical). Office and 24-h systolic and diastolic BP were significantly reduced both at 1 and 6 months after RDN and all patients were office BP responders. There was a trend toward office heart rate reduction (by 6.9 b.p.m., P=0.064) at 1 month and a significant reduction by 10 b.p.m. (P=0.004) at 6 months. Mean 24-h Holter monitoring heart rate was reduced by 6.7 b.p.m. (P=0.022) at 1 month and by 5.3 b.p.m. (P=0.010) at 6 months after RDN. The total number of premature supraventricular and ventricular contractions was significantly decreased and time- and frequency- domain indexes were increased both at 1 and at 6 months after RDN (P<0.05 for both cases). Apart from the substantial BP lowering, RDN results in significant reduction of mean heart rate and arrhythmia burden, restoring autonomic balance in responder patients with drug-resistant uncontrolled hypertension.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 digital issues and online access to articles
$119.00 per year
only $9.92 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Palatini P, Benetos A, Grassi G, Julius S, Kjeldsen SE, Mancia G et al. European Society of Hypertension. Identification and management of the hypertensive patient with elevated heart rate statement of a European Society of Hypertension Consensus Meeting. J Hypertens 2006; 24: 603–610.
Hozawa A, Inoue R, Ohkubo T, Kikuya M, Metoki H, Asayama K et al. Predictive value of ambulatory heart rate in the Japanese general population: the Ohasama study. J Hypertens 2008; 26: 1571–1576.
Messerli FH, Ventura HO, Elizardi DJ, Dunn FG, Frohlich ED . Hypertension and sudden death: increased ventricular ectopic activity in left ventricular hypertrophy. Am J Med 1984; 77: 18–22.
Manolis AJ, Rosei EA, Coca A, Cifkova R, Erdine SE, Kjeldsen S et al. Hypertension and atrial fibrillation: diagnostic approach, prevention and treatment. Position paper of the Working Group 'Hypertension Arrhythmias and Thrombosis' of the European Society of Hypertension. J Hypertens 2012; 30 (2): 239–252.
Schwarz PJ, Priori SG . Sympathetic nervous system and cardiac arrhythmias. In: Zipes DP, Jalife J (eds.) Cardiac Electrophysiology. From Cell to Bedside. WB Saunders Co: Philadelphia, PA, USA, 1990 pp 330–343.
Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Circulation 1996; 93: 1043–1065.
Singh JP, Larson MG, Tsuji H, Evans JC, O'Donnell CJ, Levy D . Reduced heart rate variability and new-onset hypertension: insights into pathogenesis of hypertension: the Framingham Heart Study. Hypertension 1998; 32: 293–297.
Schroeder EB, Liao D, Chambless LE, Prineas RJ, Evans GW, Heiss G . Hypertension, blood pressure, and heart rate variability: the Atherosclerosis Risk in Communities (ARIC) study. Hypertension 2003; 42: 1106–1111.
Malerba M, Muiesan ML, Zulli R, Rizzoni D, Calebich S, Agabiti Rosei E . Ventricular arrhythmias and changes in blood pressure and left ventricular mass induced by antihypertensive treatment in hypertensive patients. J Hypertens 1991; 9 (Suppl 6): S162–S164.
Krum H, Schlaich M, Whitburn R, Sobotka PA, Sadowski J, Bartus K et al. Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study. Lancet 2009; 373: 1275–1281.
Esler MD, Krum H, Sobotka PA, Schlaich MP, Schmieder RE, Böhm M and Symplicity HTN-2 Investigators. Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial. Lancet 2010; 376: 1903–1909.
Schmieder RE, Redon J, Grassi G, Kjeldsen SE, Mancia G, Narkiewicz K et al. ESH position paper: renal denervation-an interventional therapy of resistant hypertension. J Hypertens 2012; 30 (5): 837–841.
Mahfoud F, Lüscher TF, Andersson B, Baumgartner I, Cifkova R, Dimario C et al. Expert consensus document from the European Society of Cardiology on catheter-based renal denervation. Eur Heart J 2013; 34 (28): 2149–2157.
Grassi G . Assessment of sympathetic cardiovascular drive in human hypertension: achievements and perspectives. Hypertension 2009; 54: 690–697.
Hering D, Lambert EA, Marusic P, Walton AS, Krum H, Lambert GW et al. Substantial reduction in single sympathetic nerve firing after renal denervation in patients with resistant hypertension. Hypertension 2013; 61 (2): 457–464.
Zhao Q, Yu S, Zou M, Dai Z, Wang X, Xiao J et al. Effect of renal sympathetic denervation on the inducibility of atrial fibrillation during rapid atrial pacing. J Interv Card Electrophysiol 2012; 35: 119–125.
Worthley SG, Papademetriou V, Worthley MI, Sinhal A, Chew DP, Meredith IT et al. Safety and efficacy of a multi-electrode renal sympathetic denervation system in resistant hypertension: the EnligHTN I Trial. Eur Heart J 2013; 34 (28): 2132–2140.
Lown B, Wolf M . Approaches to sudden death from coronary heart disease. Circulation 1971; 44: 130–142.
Williams B, Lacy PS and CAFE and ASCOT (Anglo-Scandinavian Cardiac Outcomes Trial) Investigators. Impact of heart rate on central aortic pressures and hemodynamics: analysis from the CAFE (Conduit Artery Function Evaluation) study: CAFÉ Heart Rate. J Am Coll Cardiol 2009; 54: 705–713.
Bangalore S, Sawhney S, Messerli FH . Relation of beta-blocker-induced heart rate lowering and cardioprotection in hypertension. J Am Coll Cardiol 2008; 52 (18): 1482–1489.
Julius S, Palatini P, Kjeldsen SE, Zanchetti A, Weber MA, McInnes GT et al. Usefulness of heart rate to predict cardiac events in treated patients with high-risk systemic hypertension. Am J Cardiol 2012; 109 (5): 685–692.
Okin PM, Kjeldsen SE, Julius S, Hille DA, Dahlöf B, Devereux RB . Effect of changing heart rate during treatment of hypertension on incidence of heart failure. Am J Cardiol 2012; 109 (5): 699–7044.
Ukena C, Mahfoud F, Spies A, Kindermann I, Linz D, Cremers B et al. Effects of renal sympathetic denervation on heart rate and atrioventricular conduction in patients with resistant hypertension. Int J Cardiol 2013; 167 (6): 2846–2851.
Linz D, Mahfoud F, Schotten U, Ukena C, Neuberger HR, Wirth K et al. Renal sympathetic denervation suppresses postapneic blood pressure rises and atrial fibrillation in a model for sleep apnea. Hypertension 2012; 60: 172–178.
Linz D, Hohl M, Nickel A, Mahfoud F, Wagner M, Ewen S et al. Effect of renal denervation on neurohumoral activation triggering atrial fibrillation in obstructive sleep apnea. Hypertension 2013; 62 (4): 767–774.
Linz D, Mahfoud F, Schotten U, Ukena C, Hohl M, Neuberger HR et al. Renal sympathetic denervation provides ventricular rate control but does not prevent atrial electrical remodeling during atrial fibrillation. Hypertension 2013; 61 (1): 225–231.
Linz D, Wirth K, Ukena C, Mahfoud F, Pöss J, Linz B et al. Renal denervation suppresses ventricular arrhythmias during acute ventricular ischemia in pigs. Heart Rhythm 2013; 10 (10): 1525–1530.
Brandt MC, Mahfoud F, Reda S, Schirmer SH, Erdmann E, Böhm M et al. Renal sympathetic denervation reduces left ventricular hypertrophy and improves cardiac function in patients with resistant hypertension. J Am Coll Cardiol 2012; 59 (10): 901–909.
Bigger JT Jr, Fleiss JL, Steinman RC, Rolnitzky LM, Kleiger RE, Rottman JN . Correlations among time and frequency domain measures of heart period variability two weeks after acute myocardial infarction. Am J Cardiol 1992; 69: 891–898.
Parati G, Esler M . The human sympathetic nervous system: its relevance in hypertension and heart failure. Eur Heart J 2012; 33 (9): 1058–1066.
Kleiger RE, Stein PK, Bigger JT Jr . Heart rate variability: measurement and clinical utility. Ann Noninvasive Electrocardiol 2005; 10 (1): 88–101.
Lin JL, Chan HL, Du CC, Lin IN, Lai CW, Lin KT et al. Long-term beta-blocker therapy improves autonomic nervous regulation in advanced congestive heart failure: a longitudinal heart rate variability study. Am Heart J 1999; 137: 658–665.
Heusser K, Tank J, Engeli S, Diedrich A, Menne J, Eckert S et al. Carotid baroreceptor stimulation, sympathetic activity, baroreflex function, and blood pressure in hypertensive patients. Hypertension 2010; 55: 619–626.
Himmel F, Weil J, Reppel M, Mortensen K, Franzen K, Ansgar L et al. Improved heart rate dynamics in patients undergoing percutaneous renal denervation. J Clin Hypertens (Greenwich) 2012; 14 (9): 654–655.
Brinkmann J, Heusser K, Schmidt BM, Menne J, Klein G, Bauersachs J et al. Catheter-based renal nerve ablation and centrally generated sympathetic activity in difficult-to-control hypertensive patients: prospective case series. Hypertension 2012; 60 (6): 1485–1490.
Acknowledgements
CT received Research Grant and speaker honoraria by St Jude Medical and Travel Expenses by Medtronic. This study is funded by St Jude Medical in a research grant.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
VP is a consultant to St Jude Medical and part of the Steering Committee for EnligHTN IV. EL is an employee of St Jude Medical (SJM). SJM is the manufacturer of the device investigated in this study. She is also an employee of the advisory board members of SJM for studies related to the device investigated in this study. The remaining authors declare no conflict of interest.
Additional information
Supplementary Information accompanies this paper on the Journal of Human Hypertension website
Supplementary information
Rights and permissions
About this article
Cite this article
Tsioufis, C., Papademetriou, V., Tsiachris, D. et al. Drug-resistant hypertensive patients responding to multielectrode renal denervation exhibit improved heart rate dynamics and reduced arrhythmia burden. J Hum Hypertens 28, 587–593 (2014). https://doi.org/10.1038/jhh.2014.14
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/jhh.2014.14
This article is cited by
-
The autonomic balance of heart rhythm complexity after renal artery denervation: insight from entropy of entropy and average entropy analysis
BioMedical Engineering OnLine (2022)
-
Systematic review of renal denervation for the management of cardiac arrhythmias
Clinical Research in Cardiology (2022)
-
Autonomic modulation of ventricular electrical activity: recent developments and clinical implications
Clinical Autonomic Research (2021)
-
Effects of renal denervation on 24-h heart rate and heart rate variability in resistant hypertension
Clinical Research in Cardiology (2020)
-
Treatment of atrial fibrillation in patients with enhanced sympathetic tone by pulmonary vein isolation or pulmonary vein isolation and renal artery denervation: clinical background and study design
Clinical Research in Cardiology (2018)