Heart failure

Ablation of the right superior splanchnic nerve in heart failure with preserved ejection fraction

Percutaneous ablation of the right-sided greater splanchnic nerve (GSN) in patients with heart failure with preserved ejection fraction (HFpEF) improves outcomes at 12 months according to study results published in the Journal of the American College of Cardiology: Heart Failure.

The researchers sought to investigate the first-in-human use of splanchnic ablation for volume management for right-sided GSN denervation. They launched a prospective open-label single-arm trial (ClinicalTrials.gov ID: NCT04287946) of right-sided GSN ablation in patients with HFpEF between January 2020 and March 2020 at Tbilisi Cardiac and Vascular Clinic (Tbilisi, Republic of Georgia). They included 11 patients with HFpEF (aged 70 ± 8 years; 8 women), an ejection fraction of 50% or greater, elevated pulmonary capillary pressure, and functional class II or III symptoms. Follow-up of splanchnic ablation for volume management included echocardiography, Kansas City cardiomyopathy questionnaire, and 6-minute walk test at 1, 3, 6, and 12 months.

Clinical improvements are observed at 1 month and are maintained for 12 months. 6-minute walk test results improve from baseline (292 ± 82 m) at 1 month (341 ± 88 m) to 12 months (359 ± 75 m) (P <.05 kansas city cardiomyopathy questionnaire scores improve from baseline median iqr at month to months>P P =.585) at 12 months (379±165 pg/mL; P =.039).


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Limitations of the trial include the lack of a control group and blinding. There is also no minimum time between enrollment in the trial and the procedure, which may have resulted in compliance bias. Moreover, the change in splanchnic vascular capacity is not directly assessed.

“In this open-label, single-arm feasibility study, right-sided GSN ablation was safe and primarily improved subjective clinical measures in patients with HFpEF over 12 months,” the study authors wrote.

Disclosure: This research was supported by Axon Therapies. Please see the original reference for a full list of disclosures. Some study authors have declared affiliations with biotechnology, pharmaceutical and/or device companies. Please see the original citation for a full list of author disclosures.

Reference

Fudim M, Zirakashvili T, Shaburishvili N, et al. Transvenous ablation of the right greater splanchnic nerve in heart failure and preserved ejection fraction. JACC Cardiac Failure. Published online July 6, 2022. doi:10.1016/j.jchf.2022.05.009