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2017 ; 8
(23
): 37296-37307
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gab.com Text
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Renal sympathetic denervation guided by renal nerve stimulation to treat
ventricular arrhythmia in CKD patients with ICD
#MMPMID28415795
Kiuchi MG
; Chen S
; Paz LMR
; Pürerfellner H
Oncotarget
2017[Jun]; 8
(23
): 37296-37307
PMID28415795
show ga
Chronic kidney disease (CKD) patients on stage 4 present greater risk rates for
malignant ventricular arrhythmia events. This study examined patients with CKD in
stages 1, 2, 3 and 4, left ventricular dysfunction and automatic implantable
cardioverter-defibrillator (ICD). Our goal was to record the appropriate
therapies, "Anti-tachycardia Therapy Pacing" (ATP) and shock events during the 18
months of follow-up and compare the incidence and severity of these at different
stages of CKD, mainly in patients with CKD stage 4 underwent renal sympathetic
denervation (RSD) guided by renal nerve stimulation (RNS). One hundred and
fifteen patients were evaluated once every three months till 18 months of
follow-up. The arrhythmic events were assessed at each follow-up visit. Comparing
the groups, we can see the number of ATP and shock events recorded by ICD during
18 months of follow-up, and differences in the number of therapeutic events
between the various stages of CKD. The hazard ratio (HR), 95% confidence interval
(CI) and P value for ATP and shock events between all the CKD stages were
evaluated by the log-rank/Mantel-Haenszel test. At the 18th month of follow-up,
75% of patients with CKD stage 4 received ATP, and 70% were treated with shock
while only 20% of the subjects with CKD stage 4 that were submitted to RSD
received ATP and 20% were treated with shock, P<0.0001 and P=0.0002,
respectively. In our study, a decline occurred in the incidence of arrhythmias,
and therefore, appropriate ICD therapies in advanced stages of CKD, reducing the
risk rates for these events in patients with CKD on stage 4 after RSD guided by
RNS in comparison to the other CKD stages. Our results suggest that RSD can
control the higher incidence of malignant arrhythmias in advanced CKD stages.