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Balaji P, Barry MA, Tran VT, Marschner S, Lu J, Nguyen DM, Mina A, Bandodkar S, Alvarez S, James V, Ronquillo J, Varikatt W, Kovoor P, McEwan A, Thiagalingam A, Thomas SP, Qian PC. Long-Term Safety and Efficacy of Transcatheter Microwave and Radiofrequency Denervation in a Chronic Ovine Model. J Am Heart Assoc 2024; 13:e031795. [PMID: 38664237 DOI: 10.1161/jaha.123.031795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 02/26/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Transcatheter renal denervation (RDN) has had inconsistent efficacy and concerns for durability of denervation. We aimed to investigate long-term safety and efficacy of transcatheter microwave RDN in vivo in normotensive sheep in comparison to conventional radiofrequency ablation. METHODS AND RESULTS Sheep underwent bilateral RDN, receiving 1 to 2 microwave ablations (maximum power of 80-120 W for 240 s-480 s) and 12 to 16 radiofrequency ablations (180 s-240 s) in the main renal artery in a paired fashion, alternating the side of treatment, euthanized at 2 weeks (acute N=15) or 5.5 months (chronic N=15), and compared with undenervated controls (N=4). Microwave RDN produced substantial circumferential perivascular injury compared with radiofrequency at both 2 weeks [area 239.8 (interquartile range [IQR] 152.0-343.4) mm2 versus 50.1 (IQR, 32.0-74.6) mm2, P <0.001; depth 16.4 (IQR, 13.9-18.9) mm versus 7.5 (IQR, 6.0-8.9) mm P <0.001] and 5.5 months [area 20.0 (IQR, 3.4-31.8) mm2 versus 5.0 (IQR, 1.4-7.3) mm2, P=0.025; depth 5.9 (IQR, 1.9-8.8) mm versus 3.1 (IQR, 1.2-4.1) mm, P=0.005] using mixed models. Renal denervation resulted in significant long-term reductions in viability of renal sympathetic nerves [58.9% reduction with microwave (P=0.01) and 45% reduction with radiofrequency (P=0.017)] and median cortical norepinephrine levels [71% reduction with microwave (P <0.001) and 72.9% reduction with radiofrequency (P <0.001)] at 5.5 months compared with undenervated controls. CONCLUSIONS Transcatheter microwave RDN produces deep circumferential perivascular ablations without significant arterial injury to provide effective and durable RDN at 5.5 months compared with radiofrequency RDN.
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Affiliation(s)
- Poornima Balaji
- Cardiology Department Westmead Hospital Sydney NSW Australia
- Westmead Applied Research Centre University of Sydney NSW Australia
| | - Michael A Barry
- Cardiology Department Westmead Hospital Sydney NSW Australia
| | - Vu Toan Tran
- Cardiology Department Westmead Hospital Sydney NSW Australia
| | - Simone Marschner
- Westmead Applied Research Centre University of Sydney NSW Australia
| | - Juntang Lu
- Cardiology Department Westmead Hospital Sydney NSW Australia
| | - Duc Minh Nguyen
- Cardiology Department Westmead Hospital Sydney NSW Australia
- Westmead Applied Research Centre University of Sydney NSW Australia
| | - Ashraf Mina
- NSW Health Pathology Institute of Clinical Pathology and Medical Research, Westmead Hospital Sydney NSW Australia
| | - Sushil Bandodkar
- Biochemistry Department, Faculty of Medicine and Health University of Sydney Children's Hospital at Westmead Clinical School Sydney NSW Australia
| | - Shirley Alvarez
- Biochemistry Department, Faculty of Medicine and Health University of Sydney Children's Hospital at Westmead Clinical School Sydney NSW Australia
| | - Virginia James
- The Westmead Institute of Medical Research Sydney NSW Australia
| | - John Ronquillo
- Department of Anatomical Pathology Institute of Clinical Pathology and Medical Research, Westmead Hospital Sydney NSW Australia
| | - Winny Varikatt
- Department of Anatomical Pathology Institute of Clinical Pathology and Medical Research, Westmead Hospital Sydney NSW Australia
| | - Pramesh Kovoor
- Cardiology Department Westmead Hospital Sydney NSW Australia
- Westmead Applied Research Centre University of Sydney NSW Australia
- Sydney Medical School University of Sydney NSW Australia
| | - Alistair McEwan
- Westmead Applied Research Centre University of Sydney NSW Australia
- School of Electrical and Information Engineering University of Sydney NSW Australia
| | - Aravinda Thiagalingam
- Cardiology Department Westmead Hospital Sydney NSW Australia
- Westmead Applied Research Centre University of Sydney NSW Australia
- Sydney Medical School University of Sydney NSW Australia
| | - Stuart P Thomas
- Cardiology Department Westmead Hospital Sydney NSW Australia
- Westmead Applied Research Centre University of Sydney NSW Australia
- Sydney Medical School University of Sydney NSW Australia
| | - Pierre C Qian
- Cardiology Department Westmead Hospital Sydney NSW Australia
- Westmead Applied Research Centre University of Sydney NSW Australia
- Sydney Medical School University of Sydney NSW Australia
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Yamamoto E, Sueta D, Tsujita K. Renal denervation in resistant hypertension: a review of clinical trials and future perspectives. Cardiovasc Interv Ther 2022; 37:450-457. [PMID: 35474179 DOI: 10.1007/s12928-022-00854-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 03/15/2022] [Indexed: 11/25/2022]
Abstract
A previous report using the National Health and Nutrition Examination Survey demonstrated an increase in the prevalence of resistant hypertension, which does not respond to traditional therapy and medication. Studies using various animal hypertensive models have demonstrated significant blood pressure (BP) reduction following renal artery denervation (RDN). Catheter-based RDN became available in clinical trials as a possible treatment option for resistant hypertension. Although first clinical trials of RDN have demonstrated the efficacy and safety of this treatment mortality for lowering BP in patients with resistant hypertension, the role of RDN has been questioned since the results of the Symplicity HTN-3 trial. Considering the ethnic differences demonstrated in the Symplicity HTN-Japan and Global Symplicity registry, by contrast, RDN might be an effective for resistant hypertension in Asian population. Here, we discuss RDN applications and technology, the old and new clinical evidence of RDN, patients' selection of RDN responder, and optimization of RDN procedure in this review. The available evidence demonstrates that RDN could be effective in carefully selected patients with resistant hypertension, paving the way for future research in this area.
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Affiliation(s)
- Eiichiro Yamamoto
- Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science and Center for Metabolic Regulation of Healthy Aging (CMHA), Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
| | - Daisuke Sueta
- Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science and Center for Metabolic Regulation of Healthy Aging (CMHA), Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science and Center for Metabolic Regulation of Healthy Aging (CMHA), Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
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Qian PC, Barry MA, Tran VT, Lu J, McEwan A, Thiagalingam A, Thomas SP. Irrigated Microwave Catheter Ablation Can Create Deep Ventricular Lesions Through Epicardial Fat With Relative Sparing of Adjacent Coronary Arteries. Circ Arrhythm Electrophysiol 2020; 13:e008251. [PMID: 32299229 DOI: 10.1161/circep.119.008251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Radiofrequency ablation depth can be inadequate to reach intramural or epicardial substrate, and energy delivery in the pericardium is limited by penetration through epicardial fat and coronary anatomy. We hypothesized that open irrigated microwave catheter ablation can create deep myocardial lesions endocardially and epicardially though fat while acutely sparing nearby the coronary arteries. METHODS In-house designed and constructed irrigated microwave catheters were tested in in vitro phantom models and in 15 sheep. Endocardial ablations were performed at 140 to 180 W for 4 minutes; epicardial ablations via subxiphoid access were performed at 90 to 100 W for 4 minutes at sites near coronary arteries. RESULTS Epicardial ablations at 90 to 100 W produced mean lesion depth of 10±4 mm, width 18±10 mm, and length 29±8 mm through median epicardial fat thickness of 1.2 mm. Endocardial ablations at 180 W reached depths of 10.7±3.3 mm, width of 16.6±5 mm, and length of 20±5 mm. Acute coronary occlusion or spasm was not observed at a median separation distance of 2.7 mm (IQR, 1.2-3.4 mm). Saline electrodes recorded unipolar and bipolar electrograms; microwave ablation caused reductions in voltage and changes in electrogram morphology with loss of pace-capture. In vitro models demonstrated the heat sink effect of coronary flow, as well as preferential microwave coupling to myocardium and blood as opposed to lung and epicardial fat phantoms. CONCLUSIONS Irrigated microwave catheter ablation may be an effective ablation modality for deep ventricular lesion creation with capacity for fat penetration and sparing of nearby coronary arteries because of cooling endoluminal flow. Clinical translation could improve the treatment of ventricular tachycardia arising from mid myocardial or epicardial substrates.
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Affiliation(s)
- Pierre C Qian
- Cardiology Department, Westmead Hospital (P.C.Q., M.A.B., V.T.T., J.L., A.T., S.P.T.), University of Sydney, Australia.,Sydney Medical School (P.C.Q., A.T., S.P.T.), University of Sydney, Australia.,The Westmead Institute for Medical Research (P.C.Q., A.T., S.P.T.), University of Sydney, Australia
| | - Michael A Barry
- Cardiology Department, Westmead Hospital (P.C.Q., M.A.B., V.T.T., J.L., A.T., S.P.T.), University of Sydney, Australia.,School of Electrical and Information Engineering (M.A.B., A.M.), University of Sydney, Australia
| | - Vu T Tran
- Cardiology Department, Westmead Hospital (P.C.Q., M.A.B., V.T.T., J.L., A.T., S.P.T.), University of Sydney, Australia
| | - Juntang Lu
- Cardiology Department, Westmead Hospital (P.C.Q., M.A.B., V.T.T., J.L., A.T., S.P.T.), University of Sydney, Australia
| | - Alistair McEwan
- Cardiology Department, Westmead Hospital (P.C.Q., M.A.B., V.T.T., J.L., A.T., S.P.T.), University of Sydney, Australia.,School of Electrical and Information Engineering (M.A.B., A.M.), University of Sydney, Australia
| | - Aravinda Thiagalingam
- Sydney Medical School (P.C.Q., A.T., S.P.T.), University of Sydney, Australia.,The Westmead Institute for Medical Research (P.C.Q., A.T., S.P.T.), University of Sydney, Australia
| | - Stuart P Thomas
- Cardiology Department, Westmead Hospital (P.C.Q., M.A.B., V.T.T., J.L., A.T., S.P.T.), University of Sydney, Australia.,Sydney Medical School (P.C.Q., A.T., S.P.T.), University of Sydney, Australia.,The Westmead Institute for Medical Research (P.C.Q., A.T., S.P.T.), University of Sydney, Australia
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Abstract
Microwave (MW) ablation has emerged as a minimally invasive therapeutic modality and is in clinical use for treatment of unresectable tumors and cardiac arrhythmias, neuromodulation, endometrial ablation, and other applications. Components of image-guided MW ablation systems include high-power MW sources, ablation applicators that deliver power from the generator to the target tissue, cooling systems, energy-delivery control algorithms, and imaging guidance systems tailored to specific clinical indications. The applicator incorporates a MW antenna that radiates MW power into the surrounding tissue. A variety of antenna designs have been developed for MW ablation with the objective of efficiently transferring MW power to tissue, with a radiation pattern well matched to the size and shape of the targeted tissue. Here, we survey advances in percutaneous, endocavitary, and endoscopic antenna designs as an integral element of MW ablation applicators for a diverse set of clinical applications.
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Affiliation(s)
- Hojjatollah Fallahi
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, Kansas
| | - Punit Prakash
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, Kansas
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Qian PC, Barry MA, Lu J, Pouliopoulos J, Mina A, Bandodkar S, Alvarez S, James V, Ronquillo J, Varikatt W, Thiagalingam A, Thomas SP. Transvascular Pacing of Aorticorenal Ganglia Provides a Testable Procedural Endpoint for Renal Artery Denervation. JACC Cardiovasc Interv 2019; 12:1109-1120. [DOI: 10.1016/j.jcin.2019.04.047] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/26/2019] [Accepted: 04/30/2019] [Indexed: 10/26/2022]
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Almekkawy M, Chen J, Ellis MD, Haemmerich D, Holmes DR, Linte CA, Panescu D, Pearce J, Prakash P, Zderic V. Therapeutic Systems and Technologies: State-of-the-Art Applications, Opportunities, and Challenges. IEEE Rev Biomed Eng 2019; 13:325-339. [PMID: 30951478 PMCID: PMC7341980 DOI: 10.1109/rbme.2019.2908940] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this review, we present current state-of-the-art developments and challenges in the areas of thermal therapy, ultrasound tomography, image-guided therapies, ocular drug delivery, and robotic devices in neurorehabilitation. Additionally, intellectual property and regulatory aspects pertaining to therapeutic systems and technologies are addressed.
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