Abstract 19618: Effect of Electroanatomically Guided versus Conventional Renal Sympathetic Denervation on Radiation Exposure and Blood Pressure in the SAVE Trial
Introduction: SYMPLICITY -2 demonstrated that renal sympathetic denervation (RSDN) is effective in lowering blood pressure in patients with resistant hypertension. RSDN is typically performed using fluoroscopy. Our aim was to assess the clinical utility of electroanatomic mapping systems (EAM) on radiation exposure and treatment results in a prospective trial.
Methods: Pre-specified analysis of outcomes in both the non-randomized Impact of Renal Sympathetic Denervation on Chronic Hypertension (SAVE) trial (n=10), and the randomized Renal Sympathetic Denervation for the Management of Chronic Hypertension (RELIEF) trial (n=10). Both trials enroll patients with refractory HTN, defined as BP≥140/90 mmHg despite treatment with at least 3 anti-HTN drugs. Patients in the SAVE cohort underwent catheter based RSDN using EAM (NavX, CARTO), and were compared with case-matched controls in the RELIEF trial who underwent RSDN using fluoroscopy. All patients underwent bilateral renal angiography prior to RSDN, resulting in radiation exposure. Blood pressure was measured at 1 month post-procedure in an office setting.
Results: Radiation exposure was significantly reduced in the EAM group (39,175 ± 14,463 mGycm2 vs 61,209 ± 22,259 mGycm2, P=0.0172). Total procedure duration was comparable between the EAM group (77.0 ± 35.5 min) and conventional group (75.6 ± 33.8 min, P=0.8837). The SBP at 1 month (147 ± 11 vs 156 ± 19 mmHg, P=0.3662) and DBP at 1 month (91 ± 11 vs 88 ± 15 mmHg, P=0.6998) were similar between the EAM and conventional group.
Conclusion: The use of electroanatomic mapping systems during RSDN significantly reduces radiation exposure, without increasing procedure duration.
- © 2012 by American Heart Association, Inc.