Renal sympathetic denervation in mild chronic kidney disease patients with chronic heart failure without indication of cardiac resynchronization therapy: a bridge to cardiac transplantation

Background: Heart failure (HF) is a challenging disease to control. Chronic overactivation of the sympathetic nervous system occurs early in HF and chronic kidney disease (CKD). The aim of this study was to evaluate the safety and effects of renal sympathetic denervation (RSD) in reducing lesions on the heart and kidneys in patients with CKD and chronic HF refractory pharmacological therapy and QRS complex width <120 ms, waiting for cardiac transplantation. Methods and results: Eigtheen patients were included and treated with a standard irrigated cardiac ablation catheter. RSD was performed by a unique operator. All the patients included in the study had HF in functional New York Health Association (NYHA) class III, were refractory to pharmacological therapy, had QRS complex width <120 ms, and had mild CKD. Data were obtained at baseline, and at 6 and 12 months of follow-up. RSD was safe and feasible to perform in this population. No changes in blood pressure were observed during this period. At baseline, patients walked 146.2 ± 18.5 m during a 6 minutes walking test, increasing to 201.6 ± 21.8 m at 12 months post RSD (p<0.0001). All echocardiographic parameters evaluated improved at 6 and 12 months (p<0.05) after RSD. Estimated glomerular filtration rate improved from 73.6 ± 8.7 mL/min/1.73m2 at baseline to 88.0 ± 10.1 mL/min/1.73m2 at 12 months post procedure (p<0.0001). At 12 months after RSD, 11% of patients were in functional NYHA class I, 72% were in functional class II, and 17% remained in functional NYHA class III. Conclusions: RSD seemed to be safe, feasible, and effective, resulting in an improvement in echocardiographic parameters, 6 minutes walking test distance, renal function, and functional NYHA class in mild CKD patients with HF refractory to pharmacological therapy and QRS <120 ms.