Right greater splanchnic nerve Ablation useful treatment option for managing HFpEF: Study

Inappropriate control of blood volume redistribution maybe a mechanism responsible for exercise intolerance in heart failure with preserved ejection fraction (HFpEF).

A first of its kind human clinical trial was conducted by a group of researchers from the Czech Republic and Poland wherein they tried to demonstrate the effectiveness of selective blockade of sympathetic signaling to the splanchnic circulation by surgical ablation of the right greater splanchnic nerve (GSN) in HFpEF patients.

The researchers conducted a single-arm, prospective, two-center trial, among 10 patients with HFpEF all with New York Heart Association (NYHA) class III, left ventricular ejection fraction >40%, pulmonary capillary wedge pressure (PCWP) ≥15 mmHg at rest or ≥25 mmHg with supine cycle ergometry underwent ablation of the right GSN via thoracoscopic surgery.

Patients were evaluated at baseline, 1, 3, 6 and 12 months after the procedure. The primary endpoint was a reduction in exercise PCWP at 3 months.

The findings of the study are as follows:

• There were no adverse events related to the blockade of the nerve during 12-month follow-up but three patients had significant peri-procedural adverse events related to the surgical procedure itself.
• At 3 months post-GSN ablation, patients demonstrated a reduction in 20 W exercise PCWP when compared to baseline, which carried over to peak exercise.
• At 12 months, improvements were seen in NYHA class and quality of life assessed with the Minnesota Living with Heart Failure Questionnaire.

The researchers concluded that in this first-in-human study, GSN ablation in HFpEF proved to be feasible, with a suggestion of reduced cardiac filling pressure during exercise, improved quality of life and exercise capacity.

Reference:

Surgical ablation of the right greater splanchnic nerve for the treatment of heart failure with preserved ejection fraction: a first-in-human clinical trial by Málek F et. al published in the European Journal of Heart Failure.

DOI: 10.1002/ejhf.2209