Catheter-based renal denervation versus intensified medical treatment in patients with resistant hypertension: Rationale and design of a multicenter randomized study—PRAGUE-15

AbstractCatheter-based renal denervation (RDN) was considered as a promising method for treatment of resistant hypertension and was increasingly being used worldwide. However, there are equivocal results from only two randomized trials studying the effect of such intervention. Thus, additional data from properly designed long-term comparative trials are needed. The PRAGUE-15 trial is designed as an open, prospective, randomized multicenter trial comparing RDN versus intensified medical treatment in patients with resistant hypertension. Patients randomized to the medical treatment group will receive spironolactone in the absence of contraindications. The primary endpoint will be changes in systolic and diastolic pressure during ambulatory blood pressure monitoring (ABPM) from baseline to 6 months. Herein, we describe the trial design and methodology. The strengths of the trial include ABPM (as the objective endpoint), independent outcomes assessment, and therapeutic use of spironolactone

The influence of catheter-based renal sympathetic denervation on renal function and renal arteries

AbstractObjectiveCurrently investigated non-pharmacological minimally invasive method for the treatment of resistant hypertension is percutaneous denervation of renal sympathetic nerve fibres by radiofrequency catheter-based ablation. We assessed its influence on renal function and renal arteries.MethodsThe first 38 patients treated with catheter-based renal denervation at our centre between September 2011 and December 2012 were included in the study. Changes in renal function and changes in renal artery morphology at 12 months after the procedure have been analyzed.ResultsMean age was 57.6±11 years, the majority (63.9%) were men. Average estimated glomerular filtration rates (eGF) were 1.25ml/s/1,73m2 before denervation and 1.30ml/s−1/1.73m−2 12 months after intervention. Changes in eGF did not reach statistical significance. New haemodynamically non-significant renal artery stenosis (40%) has occurred in only one case after procedure.ConclusionIn agreement with the results of several studies, our findings suggest that renal denervation (RDN) appears to be a safe therapeutic approach

Ventricular fibrillation associated with aortic stenosis and coronary cascade

AbstractWe report a case of a patient with severe aortic stenosis in the setting of bicuspid valve and coronary cascade, who was successfully resuscitated from ventricular fibrillation occurring during physical exertion. Both conditions may cause steal effect leading to myocardial ischemia and ensuing ventricular tachyarrhythmia. Following replacement of the aortic valve by mechanical valve prosthesis, the patients declined implantation of cardioverter-defibrillator rendering doubts about possible independent association between ventricular fibrillation and coronary cascade