Cross talk between renal and cardiac autonomic nerves: is this how renal denervation works?

Surgical renal sympathetic denervation (RSD) has been used to control resistant hypertension.1 With the development of catheter based RSD, this old technique has been resuscitated for the treatment of hypertension. While initial clinical studies showed effective hypertension control,2 a recent sham-controlled randomized clinical trial failed to confirm its antihypertensive efficacy.3 These negative studies notwithstanding, RSD has been actively pursued as a tool to control various types of cardiac arrhythmias.4, 5 The mechanisms by which RSD helps arrhythmia control remain poorly understood. In the present issue of the Journal, Huang et al6 reported in anesthetized dogs that left renal nerve stimulation facilitates ischemia induced ventricular arrhythmia by increasing the function of the left stellate ganglion (LSG). LSG ablation attenuated these arrhythmias. This report suggests that there is a direct interaction between the left renal sympathetic nerve and the LSG. Is it possible that the cross talk between these two nerve structures underlies the antiarrhythmic mechanisms of RSD?