Radiofrequency renal artery denervation: technical issues of different approaches and safety

Objective. To describe the technical issues and safety of renal denervation (RD) when using a multielectrode radiofrequency (RF) bipolar balloon catheter, a multielectrode unipolar RF spiral catheter, and an electrophysiological (EP) 3,5-mm RF ablation catheter. Design and methods. Between 2016 and 2019, 54 patients undergoing renal artery (RA) denervation were included into a prospective observational study: 27 procedures were performed using the balloon technology, 21 — using the spiral; and 6 — using a steerable irrigated EP catheter under three-dimensional electroanatomical guidance. In 50 patients RD was performed due to resistant arterial hypertension, and in 4 — due to intractable ventricular tachyarrhythmias. Results. The use of the spiral catheter was associated with a higher number of RF points in the RA, when compared with balloon ablation and EP catheter ablation (22,3 ± 9,6 vs. 13,4 ± 5,5 vs. 8,7 ± 2,1, p < 0,01). In the balloon ablation group, a direct correlation between the number of RF points and the sharpest RA angle was found (correlation coefficient — 0,82). We observed the following complications: in the balloon ablation group — 1 dissection of the RA and 1 aneurysm of the right femoral artery (7,4 %); in the spiral ablation group — 1 aneurysm and 1 pulsating hematoma of the right femoral artery (9,5 %); in the electrophysiological electrode ablation group — 1 dissection of the RA, 1 aneurysm of the right femoral artery (33,4 %). Conclusions. The use of the spiral multielectrode catheter is associated with the higher number of RF applications, including ablation inside distal branches. The number of RF points depends on the artery tortuosity when performing balloon-based ablation. Manipulations inside the RA using the EP catheter might not be safe.

renal denervation, ablation, renal arteries

1. Oganov RG, Timofeeva TN, Koltunov IE, Konstantinov VV, Balanova YA, Kapustina AV et al. Arterial hypertension epidemiology in Russia. The results of 20032010 federal monitoring. Cardiovasc Ther Prev. 2011;10(1):9–13. In Russian.

2. Smithwick RH, Thompson JE. Splanchnicectomy for essential hypertension: results in 1,266 cases. J Am Med Assoc. 1953;152(16):1501–1504.

3. Vander MA, Fedotov PA, Lyubimtseva TA, Bortsova MA, Sitnikova MY, Lebedev DS et al. Renal artery denervation suppresses intractable ventricular arrhythmia in patients with left heart thrombosis. J Geriatr Cardiol. 2017;14(9):587–589.

4. Steinberg JS, Shabanov V, Ponomarev D, Losik D, Ivanickiy E, Kropotkin E et al. Effect of renal denervation and catheter ablation vs catheter ablation alone on atrial fibrillation recurrence among patients with paroxysmal atrial fibrillation and hypertension: The ERADICATE-AF Randomized Clinical Trial. J Am Med Assoc. 2020;323(3):248–255.

5. Bradfield JS, Hayase J, Liu K, Moriarty J, Kee ST, Do D et al. Renal denervation as an adjunctive therapy to cardiac sympathetic denervation for ablation refractory ventricular tachycardia. Heart Rhythm. 2020;17(2):220–227.

6. Zyubanova IV, Mordovin VF, Pekarskiy SE, Ripp TM, Falkovskaya AY, Lichikaki VA et al. Possible mechanisms of renal denervation long-term cardiac effects. Arterial Hypertension = Arterial’naya Gipertenziya. 2019;25(4):423–432. doi:10.18705/1607-419X2019-25-4-423-432. In Russian.

7. Ivanov KE, Mitrofanova LB, Garkina SV, Mikhaylov EN, Lebedev DS. Histological characteristics of human renal artery nerves and neural ganglia. Arterial Hypertension = Arterial’naya Gipertenziya. 2018;24(5):515–520. doi:10.18705/1607-419X-2018-24-5-515-520. In Russian.

8. Pekarskiy SE, Baev AE, Mordovin VF, Semke GV, Ripp TM, Falkovskaya AU et al. Denervation of the distal renal arterial branches vs. conventional main renal artery treatment: a randomized controlled trial for treatment of resistant hypertension. J Hypertens. 2017;35(2):369–375.

9. Hamon M, Pristipino C, Di Mario C, Nolan J, Ludwig J, Tubaro M et al. Consensus document on the radial approach in percutaneous cardiovascular interventions: position paper by the European Association of Percutaneous Cardiovascular Interventions and Working Groups on Acute Cardiac Care and Thrombosis of the European Society of Cardiology. EuroIntervention. 2013;8(11):1242–1251.

10. Schahab N, Kavsur R, Mahn T, Schaefer C, Kania A, Fimmers R et al. Endovascular management of femoral access-site and access-related vascular complications following percutaneous coronary interventions. PLoS ONE. 2020;15(3):e0230535.

11. Templin C, Jaguszewski M, Ghadri JR, Sudano I, Gaehwiler R, Hellermann JP et al. Vascular lesions induced by renal nerve ablation as assessed by optical coherence tomography: pre- and post-procedural comparison with the Simplicity catheter system and the EnligHTN multi-electrode renal denervation catheter. Eur Heart J. 2013;34(28):2141–2148b.

12. Rippy MK, Zarins D, Barman NC, Wu A, Duncan KL, Zarins CK. Catheter-based renal sympathetic denervation: chronic preclinical evidence for renal artery safety. Clin Res Cardiol. 2011;100(12):1095–1101.

13. Sakakura K, Ladich E, Fuimaono K, Grunewald D, O'Fallon P, Spognardi AM, et al. Comparison of renal artery, soft tissue, and nerve damage after irrigated versus nonirrigated radiofrequency ablation. Circ Cardiovasc Interv. 2014;8(1):e001720.

14. Weber MA, Kirtane AJ, Weir MR, Radhakrishnan J, Das T, Berk M et al. The REDUCE HTN: REINFORCE: Randomized, sham-controlled trial of bipolar radiofrequency renal denervation for the treatment of hypertension. JACC Cardiovasc Interv. 2020;13(4):461–470.

15. Guo X, Zhai F, Nan Q. The temperature field simulation of radiofrequency catheter-based renal sympathetic denervation for resistant hypertension. Biomed Mater Eng. 2014;24(1):315–321.