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The biophysics of renal sympathetic denervation using radiofrequency energy

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Abstract

Renal sympathetic denervation is currently performed in the treatment of resistant hypertension by interventionists who otherwise do not typically use radio-frequency (RF) energy ablation in their clinical practice. Adequate RF lesion formation is dependent upon good electrode-tissue contact, power delivery, electrode-tissue interface temperature, target-tissue impedance and the size of the catheter’s active electrode. There is significant interplay between these variables and hence an appreciation of the biophysical determinants of RF lesion formation is required to provide effective and safe clinical care to our patients. In this review article, we summarize the biophysics of RF ablation and explain why and how complications of renal sympathetic denervation may occur and discuss methods to minimise them.

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Acknowledgments

Dr Patel and Dr Hayward acknowledge financial support from the Department of Health via the National Institute of Health Research (NIHR) Biomedical Research Unit award to the Royal Brompton National Health Service Trust. Dr Lyon is in receipt of a British Heart Foundation Intermediate Clinical Fellowship. Dr Mahfoud is supported by Deutsche Hochdruckliga, Deutsche Forschungsgemeinschaft and Deutsche Gesellschaft für Kardiologie. FM received scientific support from Medtronic, St. Jude, Vessix and ReCor and received speaker honorarium from Medtronic, St. Jude and Cordis. Professor di Mario has received Speaker’s fees from Medtronic Inc. The other authors have no conflicts to report.

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Authors and Affiliations

  1. Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Hospitals, London, SW3 6NP, UK

    Hitesh C. Patel, Paramdeep S. Dhillon, Alistair C. Lindsay, Carl Hayward, Sabine Ernst, Alexander R. Lyon, Stuart D. Rosen & Carlo di Mario

  2. Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany

    Felix Mahfoud

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  1. Hitesh C. Patel
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  2. Paramdeep S. Dhillon
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  3. Felix Mahfoud
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  4. Alistair C. Lindsay
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  7. Alexander R. Lyon
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  8. Stuart D. Rosen
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  9. Carlo di Mario
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Correspondence to Hitesh C. Patel.

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Patel, H.C., Dhillon, P.S., Mahfoud, F. et al. The biophysics of renal sympathetic denervation using radiofrequency energy. Clin Res Cardiol 103, 337–344 (2014). https://doi.org/10.1007/s00392-013-0618-6

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  • DOI: https://doi.org/10.1007/s00392-013-0618-6

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