CLINICAL ASSESSMENT OF RADIOFREQUENCY CARDIAC DENERVATION

To study radiofrequency cardiac denervation, 32 patients aged 60.0±9.4 years with acquired valvular heart disease (13 men and 19 women) were examined and treated. Mitral stenosis was documented in 15 patients, mitral insufficiency, in 13 subjects, and aortic stenosis, in 4 ones. According to the 6 minute walk test data (6MWT), 21 patients were considered as heart failure subjects of Functional Class III (NYHA); 11 patients had Functional Class II (NYHA). The average functional class was 2.3±1.1. Beta-adrenoblockers (β AB) were received by 29 patients (90.6%), angiotensin-converting enzyme inhibitors (ACEI) and diuretics were taken by all study subjects; 5 patients (16%) took Digoxin. Coronary angiography was performed to all patients before intervention. The cardiac sympathetic tone was assessed using scintigraphy with 123I-metaiodobenzylguanidine (123I-MIBG). The overall sympathetic activity was assessed on the basis of the heart/mediastinum ratio (H/M) and the indicator clearance. Valvular disease was surgically corrected in all subjects. Group I consisted of 21 patients with long-term persistent atrial fibrillation (AF). In them, the surgical correction of valvular disease was accompanied by with the labyrinth radiofrequency atrial fragmentation with destruction of para-ganglionic nervous plexuses. 11 patients with the sinus rhythm constituted Group II. No radiofrequency procedure was performed in them. All study subjects were discharged from hospital. The sinus rhythm recovered in 19 patients (90.5%) of Group I; one female patient (4.75%) required pacemaker implantation, in one more patient (4.75%), left atrial incision tachycardia persisted. According to the 6MWT data, the functional class of heart failure improved in both groups by 1.2±0.7 functional class (NYHA) in Group I and by 1.1±0.2 functional class in Group II. Before the radiofrequency procedure, the H/M index in Group I was significantly lower (1.64±0.21 and 1.9±0.27, respectively; p<0.05) and the indicator clearance was significantly higher (30.21±10.43% and 21.94±15.01%, respectively; p<0.05) than in Control Group. After the radiofrequency treatment, in Group I, the significant decrease in the H/M index as compared with the preoperation data was noted (1.64±0.21 and 1.42±0.18, respectively; p<0.05) but an increase in the defect of the indicator accumulation occurred (11.1±5.6% and 24.9±7.56%, respectively; p<0.05). In Group II., after the procedure only a statistically significant fall of the H/M index was found (1.9±0.27 and 1.63±0.24, p<0.05). After the procedure, a significant inter-group difference was found for the 123I-MIBG clearance (36±13.38% and 25.14±9.96%, respectively; p<0.05). In addition, the H/M index after radiofrequency procedure in Group I was significantly lower than in Group II (1.42±0.18 and 1.63±0.24, respectively; p<0.05). When assessing the regional sympathetic activity in the patients of Group I, the 123I-MIBG accumulation defect was significantly more pronounced than in Group II (24.9±7.56% and 13.7±5.81%, respectively; p<0.05). Thus, the 123I-MIBG cardiac accumulation defect after the radiofrequency procedure and an increased clearance as compared to the pre-procedure data and the control group give evidence of a decreased number of norepinephrine receptors and, therefore, a decreased overall sympathetic cardiac tone.

acquired valvular disease, long-term persisting atrial fibrillation, sympathetic modulation, radiofrequency catheter ablation, denervation, scintigraphy, 123I metaiodobenzylguanidine

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