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A new clinical trial is now underway at the MGH to investigate whether combining two catheter-based procedures will improve the long-term outcome in the treatment of atrial fibrillation, the most common heart rhythm disorder. The MGH is the first hospital in New England – and only the second in the nation – to pair renal artery sympathetic denervation with pulmonary vein isolation (PVI) for patients with atrial fibrillation and hypertension.
“Typically these procedures are done separately,” said Moussa Mansour, MD, director of the Atrial Fibrillation Program in the MGH Institute for Heart, Vascular and Stroke Care. “In this trial, renal denervation is not only performed to treat the patient’s hypertension, which is the usual goal of the procedure, but as an adjunct to PVI to improve the outcome of atrial fibrillation ablation. We see real potential in this treatment for patients who continue to experience atrial fibrillation symptoms in spite of medical treatment as well as for those who cannot tolerate antiarrhythmic drugs. Atrial fibrillation affects more than three million people in the U.S. and is a major cause of stroke.”
On June 17, MGH physicians used the combined techniques to treat a 60-year-old patient with chronic heart disease. PVI – in which a flexible catheter is passed into the heart through a vein in the leg to disrupt the electrical connection between the pulmonary veins and the rest of the heart – can eliminate atrial fibrillation in most patients. Renal sympathetic denervation uses radiofrequency pulses to interrupt nerves in the vascular wall of the kidney. It is believed the procedure reduces the activity of the sympathetic nervous system which in turn leads to reduction in atrial fibrillation.
“This procedure capitalizes on the strengths of the electrophysiologists in the use of ablation catheters, and the vascular medicine physician in the imaging of the renal arteries and associated interventions in this locale,” said Joseph Garasic, MD, director of Peripheral Vascular Intervention in the Cardiology Division, Institute for Heart, Vascular and Stroke Care. “It also marks the first time we have performed the renal denervation procedure at the MGH. Increasing evidence has shown that this procedure may have even more far-reaching benefits in the treatment of other diseases beyond uncontrolled hypertension – including heart failure, sleep apnea and cardiac arrhythmias.”
The patient treated in June will now continue to be evaluated on a regular basis to study the procedure’s effectiveness. The clinical trial is slated to last about two years, and the MGH expects to treat two to three patients a month with the new procedure.
“This clinical trial is unique in that it allows for a solid collaboration and integration of skills between experts in the MGH Atrial Fibrillation Service and Vascular Medicine Service, both key components of the Institute for Heart, Vascular and Stroke Care,” Mansour said. “This is the most recent and most advanced treatment option to help treat our cardiac patients and improve their heart health and their overall lives.”