Pulmonary Artery Denervation by Determining Targeted Ablation Sites for Treatment of Pulmonary Arterial Hypertension

• DOI: 10.1161/circinterventions.117.005812
• Publication Date: 2017-10-18T00:40:22Z
• Authors: Taishi Fujisawa; Masaharu Kataoka; Takashi Kawakami; Sarasa Isobe; Kazuaki Nakajima; Akira Kunitomi; Shin Kashimura; Yoshinori Katsumata; Takahiko Nishiyama; Takehiro Kimura; Nobuhiro Nishiyama; Yoshiyasu Aizawa; Mitsushige Murata; Keiichi Fukuda; Seiji Takatsuki
• Keywords: Adult; Computed Tomography Angiography; Hypertension, Pulmonary; Pulmonary Artery; Electric Stimulation; 3. Good health; Electrocardiography; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Multidetector Computed Tomography; Autonomic Denervation; Catheter Ablation; Humans; Arterial Pressure; Female

At 19 years of age, a woman experiencing dyspnea on exertion was diagnosed with idiopathic pulmonary arterial hypertension. Pulmonary arterial hypertension–targeted drugs (oral beraprost, sildenafil, tadalafil, macitentan, and subcutaneous treprostinil) were administered sequentially. However, the patient’s symptoms, World Health Organization functional class II or III, persisted. The patient refused to start intravenous epoprostenol because of cosmetic concerns and was referred to our hospital at 38 years of age. Right-sided heart catheterization revealed mean pulmonary arterial pressure of 72 mm Hg and pulmonary vascular resistance of 13.0 Wood units. The patient developed right-sided heart failure twice within 1 year, which was poorly controlled by conventional therapy. Previous studies have reported that pulmonary artery denervation with radiofrequency catheter ablation of the pulmonary artery trunk significantly improves pulmonary hypertension.1,2 We undertook a clinical study to investigate a novel method of pulmonary artery denervation using a commercially available radiofrequency ablation catheter, in part because the circular ablation …