Renal Denervation Prevents Atrial Arrhythmogenic Substrate Development in CKD

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningfagfællebedømt

Dokumenter

  • Fulltext

    Forlagets udgivne version, 8,66 MB, PDF-dokument

  • Mathias Hohl
  • Simina Ramona Selejan
  • Jan Wintrich
  • Ulrike Lehnert
  • Thimoteus Speer
  • Clara Schneider
  • Muriel Mauz
  • Philipp Markwirth
  • Dickson W.L. Wong
  • Peter Boor
  • Andrey Kazakov
  • Martin Mollenhauer
  • Barbara Mara Klinkhammer
  • Ulrich Hübner
  • Christian Ukena
  • Julia Moellmann
  • Michael Lehrke
  • Stefan Wagenpfeil
  • Christian Werner
  • Felix Mahfoud
  • Michael Böhm

Background: In patients with chronic kidney disease (CKD), atrial fibrillation (AF) is highly prevalent and represents a major risk factor for stroke and death. CKD is associated with atrial proarrhythmic remodeling and activation of the sympathetic nervous system. Whether reduction of the sympathetic nerve activity by renal denervation (RDN) inhibits AF vulnerability in CKD is unknown. Methods: Left atrial (LA) fibrosis was analyzed in samples from patients with AF and concomitant CKD (estimated glomerular filtration rate [eGFR], <60 mL/min per 1.73 m2) using picrosirius red and compared with AF patients without CKD and patients with sinus rhythm with and without CKD. In a translational approach, male Sprague Dawley rats were fed with 0.25% adenine (AD)-containing chow for 16 weeks to induce CKD. At week 5, AD-fed rats underwent RDN or sham operation (AD). Rats on normal chow served as control. After 16 weeks, cardiac function and AF susceptibility were assessed by echocardiography, radiotelemetry, electrophysiological mapping, and burst stimulation, respectively. LA tissue was histologically analyzed for sympathetic innervation using tyrosine hydroxylase staining, and LA fibrosis was determined using picrosirius red. Results: Sirius red staining demonstrated significantly increased LA fibrosis in patients with AF+CKD compared with AF without CKD or sinus rhythm. In rats, AD demonstrated LA structural changes with enhanced sympathetic innervation compared with control. In AD, LA enlargement was associated with prolonged duration of induced AF episodes, impaired LA conduction latency, and increased absolute conduction inhomogeneity. RDN treatment improved LA remodeling and reduced LA diameter compared with sham-operated AD. Furthermore, RDN decreased AF susceptibility and ameliorated LA conduction latency and absolute conduction inhomogeneity, independent of blood pressure reduction and renal function. Conclusions: In an experimental rat model of CKD, RDN inhibited progression of atrial structural and electrophysiological remodeling. Therefore, RDN represents a potential therapeutic tool to reduce the risk of AF in CKD, independent of changes in renal function and blood pressure.

OriginalsprogEngelsk
TidsskriftCirculation Research
Vol/bind130
Udgave nummer6
Sider (fra-til)814-828
Antal sider15
ISSN0009-7330
DOI
StatusUdgivet - 18 mar. 2022

Bibliografisk note

Funding Information:
This work was funded by the Deutsche Forschungsgemeinschaft (DFG; German Research Foundation) project ID 322900939 (SFB TRR219-M02, S-01, S-02, C-08, M-01, M-03, M-06). M. Mollenhauer was funded by DFG (German Research Foundation; 397484323-TRR259, 360043781-GRK 2407, and 437042528-MO 3438/2-1). P. Boor was funded by DFG (project ID 454024652) and the European Research Council under the European Union’s Horizon 2020 research and innovation program (grant agreement No. 101001791). B.M. Klinkhammer was funded by the DFG (Project-ID 445703531).

Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.

ID: 316681399