Current Cardiology Reports

, 15:392 | Cite as

Renal Denervation for Arrhythmias: Hope or Hype?

  • Jonathan S. SteinbergEmail author
  • Evgeny Pokushalov
  • Suneet Mittal
Invasive Electrophysiology and Pacing (J Singh, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Invasive Electrophysiology and Pacing


Renal artery denervation (RDN) has been introduced as an ablation procedure that can effectively treat drug-resistant forms of hypertension. The ablative lesions reduce the afferent and efferent sympathetic nerve traffic to and from the kidneys, thus improving blood pressure control. Because of better control of blood pressure, and because the procedure reduces central sympathetic output to sensitive structures within the cardiovascular system, it has been hypothesized that RDN may be a valuable antiarrhythmic intervention. Preliminary results using RDN for atrial fibrillation control are promising. This review focuses on the mechanisms by which RDN may function as an antiarrhythmic treatment and early clinical results.


Renal artery denervation Antiarrhythmia Atrial fibrillation Ventricular tachycardia Arrhythmias 


Compliance with Ethics Guidelines

Conflict of Interest

Jonathan S. Steinberg has been a consultant for and has received grant support from Medtronic, St. Jude Medial, and Biosense-Webster.

Evgeny Pokushalov declares that he has no conflict of interest.

Suneet Mittal declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Stella A, Zanchetti A. Functional role of renal afferents. Physiol Rev. 1991;71:659–82.PubMedGoogle Scholar
  2. 2.
    DiBona GF, Kopp UC. Neural control of renal function. Physiol Rev. 1997;77:75–197.PubMedGoogle Scholar
  3. 3.
    Ye S, Ozgur B, Campese VM. Renal afferent impulses, the posterior hypothalamus, and hypertension in rats with chronic renal failure. Kidney Int. 1997;51:722–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Elvan A, Wylie K, Zipes DP. Pacing-induced chronic atrial fibrillation impairs sinus node function in dogs; electrophysiological remodeling. Circulation. 1996;94:2953–60.PubMedCrossRefGoogle Scholar
  5. 5.
    Kumagai K, Nakashima H, Urata H, et al. Effects of angiotensin II type 1 receptor antagonist on electrical and structural remodeling in atrial fibrillation. J Am Coll Cardiol. 2003;41:2197–204.PubMedCrossRefGoogle Scholar
  6. 6.
    Nakashima H, Kumagai K, Urata H, et al. Angiotensin II antagonist prevents electrical remodeling in atrial fibrillation. Circulation. 2000;101:2612–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Berkowitsch A, Neumann T, Kuniss M, et al. Therapy with renin-angiotensin system blockers after pulmonary vein isolation in patients with atrial fibrillation: who is a responder? PACE. 2010;33:1101–11.PubMedCrossRefGoogle Scholar
  8. 8.
    Healy JS, Baranchuk A, Crystal E, et al. Prevention of atrial fibrillation with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: a meta-analysis. J Am Coll Cardiol. 2005;45:1832–9.CrossRefGoogle Scholar
  9. 9.
    GISSI-AF Investigators. Valsartan for prevention of recurrent atrial fibrillation. N Eng J Med. 2009;360:1606–17.CrossRefGoogle Scholar
  10. 10.
    Schlaich MP, Kaye DM, Lambert E, et al. Relation between cardiac sympathetic activity and hypertensive left ventricular hypertrophy. Circulation. 2003;108:560–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Burns J, Sivananthan MU, Ball SG, et al. Relationship between central sympathetic drive and magnetic resonance imaging-determined left ventricular mass in essential hypertension. Circulation. 2007;115:1999–2005.PubMedCrossRefGoogle Scholar
  12. 12.
    Kaye DM, Lambert GW, Lefkovits J, et al. Neurochemical evidence of cardiac sympathetic activation and increased central nervous system norepinephrine turnover in severe congestive heart failure. J Am Coll Cardiol. 1994;23:570–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Kaye DM, Lefkovits J, Jennings GL, et al. Adverse consequences of high sympathetic nervous activity in the failing human heart. J Am Coll Cardiol. 1995;26:1257–63.PubMedCrossRefGoogle Scholar
  14. 14.
    Yang SS, Han W, Cao Y, et al. Effects of high thoracic epidural anesthesia on atrial electrophysiological characteristics and sympathetic nerve sprouting in a canine model of atrial fibrillation. Basic Res Cardiol. 2011;106:495–506.PubMedCrossRefGoogle Scholar
  15. 15.
    Tan AY, Zhou S, Ogawa M, et al. Neural mechanisms of paroxysmal atrial fibrillation and paroxysmal atrial tachycardia in ambulatory canines. Circulation. 2008;118:916–25.PubMedCrossRefGoogle Scholar
  16. 16.
    Sobotka PA, Mahfoud F, Schlaich MP, et al. Sympatho-renal axis in chronic disease. Clin Res Cardiol. 2011;100:1049–57.PubMedCrossRefGoogle Scholar
  17. 17.
    Schlaich MP, Sobotka PA, Krum H, Lambert E, Esler MD. Renal sympathetic-nerve ablation for uncontrolled hypertension. N Eng J Med. 2009;361:932–4.CrossRefGoogle Scholar
  18. 18.
    Patterson E, Po SS, Scherlag BJ, Lazzara R. Triggered firing of pulmonary veins by in vitro autonomic nerve stimulation. Hear Rhythm. 2005;2:624–31.CrossRefGoogle Scholar
  19. 19.
    Lau DH, Mackenzie L, Kelly DJ, et al. Hypertension and atrial fibrillation: evidence of progressive atrial remodeling with electrostructural correlate in a conscious chronically instrumented ovine model. Hear Rhythm. 2010;7:1282–90.CrossRefGoogle Scholar
  20. 20.
    Linz D, Mahfoud F, Schotten U, et al. Renal sympathetic denervation provide ventricular rate control but does not prevent atrial electrical remodeling during atrial fibrillation. Hypertension. 2013;61:225–31.PubMedCrossRefGoogle Scholar
  21. 21.
    Zhao Q, Yu S, Zou M, et al. Effects of renal sympathetic denervation on the inducibility of atrial fibrillation during rapid atrial pacing. JICE. 2012;35:119–25.Google Scholar
  22. 22.
    Linz D, Mahfoud F, Schotten U, et al. Renal sympathetic denervation suppresses postapneic blood pressure rises and atrial fibrillation in a model for sleep apnea. Hypertension. 2012;60:172–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Kline RL, Mercer PF. Functional reinnervation and development of supersensitivity to NE after renal denervation in rats. Am J Physiol. 1980;238:R353–8.PubMedGoogle Scholar
  24. 24.
    Arrowood JA, Goureau JA, Minisi AJ, Davis AB, Mohanty PK. Evidence against reinnervation of cardiac vagal afferents after human orthotopic cardiac transplantation. Circulation. 1995;92:402–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Grassi G. Assessment of sympathetic cardiovascular drive in human hypertension: achievements and perspectives. Hypertension. 2009;54:690–7.PubMedCrossRefGoogle Scholar
  26. 26.
    •• Pokushalov E, Romanov A, Corbucci G, et al. A randomized comparison of pulmonary vein isolation with versus without concomitant renal artery denervation in patients with refractory symptomatic atrial fibrillation and resistant hypertension. J Am Coll Cardiol. 2012;60:1163–70. This is the first study, performed as a prospective randomized trial, to demonstrate proof of principle that RDN may have clinical antiarrhythmic efficacy for AF. PubMedCrossRefGoogle Scholar
  27. 27.
    Krum H, Schlaich M, Whitbourn R, et al. Catheter-based renal sympathetic denervation for resistant hypertension: a multicenter safety and proof of principle study. Lancet. 2009;373:1275–81.PubMedCrossRefGoogle Scholar
  28. 28.
    Schlaich MP, Socratous F, Hennebry S, et al. Sympathetic activation in chronic renal failure. J Am Soc Nephrol. 2009;20:933–9.PubMedCrossRefGoogle Scholar
  29. 29.
    • Ukena C, Bauer A, Mahfoud F, et al. Renal sympathetic denervation for treatment of electrical storm: first-in-man experience. Clin Res Cardiol. 2012;101:63–7. This is the first report of the potential value of RDN to treat refractory VT in patients. PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Jonathan S. Steinberg
    • 1
    • 2
    • 4
    Email author
  • Evgeny Pokushalov
    • 3
  • Suneet Mittal
    • 1
    • 2
  1. 1.Arrhythmia Institute, Valley Health SystemColumbia University College of Physicians & SurgeonsNew YorkUSA
  2. 2.Arrhythmia Institute, Valley Health SystemColumbia University College of Physicians & SurgeonsRidgewoodUSA
  3. 3.State Research Institute of Circulation PathologyNovosibirskRussia
  4. 4.New YorkUSA

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