Selective proximal renal denervation guided by autonomic responses evoked via high-frequency stimulation in a preclinical XXXX model.

@entity235 @entity1063
BACKGROUND: Electric stimulation has been proved to be available to monitor the efficacy of renal denervation (RDN). This study was to evaluate the effectiveness of high-frequency stimulation (HFS)-guided proximal RDN. METHODS AND RESULTS: A total of 13 Chinese Kunming @entity235 were included and allocated to proximal RDN group (n=8) and control group (n=5). HFS (20 Hz, 8 V, pulse width 2 ms) was performed from proximal to distal renal artery in all @entity235 . Radiofrequency ablations were delivered in proximal RDN group and only at the proximal positive sites where systolic blood pressure (BP) increased >= 10 mm   Hg during HFS. Postablation HFS was performed over the previously stimulated sites. BP, heart rate, and plasma @entity1063 were analyzed. In 8 denervated @entity235 , preablation HFS caused significant BP increases of 6.0  5.0/3.4  5.5, 16.9  11.7/11.1  8.5, and 17.1  8.4/8.5  5.3 mm   Hg during the first, second, and third 20 s of HFS at the proximal positive sites. After ablation, these sites showed a negative response to postablation HFS with increases of BP by 1.3  3.0/1.0  2.5, 0.8  3.9/1.5  3.4, and 1.5  4.5/0.7  3.8 mm   Hg. Of note, no radiofrequency applications were delivered at the positive sites of middle renal artery, repeated HFS increased BP only by 3.3  5.3/2.8  4.2, 5.3  6.6/3.8  4.7, and 2.9  4.6/1.3  3.2 mm   Hg, failed to reproduce the previous BP increases of 6.2  5.6/5.3  4.4, 15.0  9.3/10.2  6.2, and 14.9  7.7/8.4  4.7 mm   Hg. At 3 months, BP and plasma @entity1063 substantially decreased in proximal RDN group. Whereas controls showed minimal BP decreases and had similar plasma @entity1063 concentrations as baseline. CONCLUSIONS: Renal afferent nerves can be mapped safely, and HFS-guided targeted proximal RDN can achieve apparent BP reduction and sympathetic inhibition.
