RDN for Heart Failure

Prior treatment

• Acute heart failure episode or decompensation within 1 month prior to enrollment.
• History of major surgery or trauma within 3 months prior to enrollment, history of acute coronary syndrome (ACS) within 6 months, or planned surgery or cardiovascular intervention within the next 6 months.
• Persistent or permanent atrial fibrillation; history of ventricular fibrillation or polymorphic ventricular tachycardia; or prior implantation of implantable cardioverter-defibrillator (ICD), cardiac resynchronization therapy (CRT) device, or permanent pacemaker.
• Concomitant serious medical conditions that would interfere with study participation or affect survival, such as malignancy or acquired immunodeficiency syndrome (AIDS).

Other illness

• Secondary hypertension (e.g., primary aldosteronism, pheochromocytoma/paraganglioma, Cushing's syndrome, thyroid disorders, aortic coarctation, monogenic hypertension, renovascular hypertension, etc.).
• History of allergy or hypersensitivity to contrast media.
• Primary pulmonary arterial hypertension.
• History of systemic embolism within 6 months.
• History of stroke or transient ischemic attack (TIA) within 6 months.
• Severe peripheral vascular disease or abdominal aortic aneurysm.
• Significant (severe) valvular heart disease.
• Acute or severe systemic infection.
• Conditions associated with chronic high-output states, such as severe anemia, advanced liver disease, hyperthyroidism, or arteriovenous fistula.
• Any condition that, in the opinion of the investigator, makes the participant unsuitable for participation in this study.

Lab values

• Presence of a single kidney, history of renal transplantation, or estimated glomerular filtration rate (eGFR) \<40 mL/min/1.73m².
• Type 1 diabetes mellitus or poorly controlled Type 2 diabetes mellitus (HbA1c \>6.5%).
• Significant bleeding diathesis or hematologic disorders (platelet count \<50×10⁹/L, or coagulation abnormalities: activated partial thromboplastin time \[APTT\] or prothrombin time \[PT\] \>3 times upper limit of normal \[ULN\], or international normalized ratio \[INR\] \>1.5).
• Severe hepatic impairment (alanine aminotransferase \[ALT\], aspartate aminotransferase \[AST\], or total bilirubin \>3 times the upper limit of normal \[ULN\]).

Other

• Pregnancy or planned pregnancy.
• Unsuitable renal artery anatomy for ablation on one or both sides (e.g., renal artery stenosis \>50%, renal artery aneurysm, renal artery malformation, renal artery diameter \<3 mm, or treatable segment length \<20 mm).
• Office systolic blood pressure (OSBP) ≤100 mmHg or 24-hour mean ambulatory systolic blood pressure (24hASBP) \<90 mmHg.
• Symptomatic orthostatic hypotension.
• Hypertrophic cardiomyopathy, restrictive cardiomyopathy, or dilated cardiomyopathy.

• Aged \>18 years and ≤75 years with a clinical diagnosis of heart failure.
• Receiving optimized guideline-directed medical therapy (GDMT) for heart failure at stable doses for ≥4 weeks (diuretics stable for ≥2 weeks), with left ventricular ejection fraction (LVEF) ≤40% (HFrEF) or ≥50% (HFpEF).
• Symptomatic with exertional dyspnea or chest tightness; New York Heart Association (NYHA) functional class II or III.
• Serum N-terminal pro-brain natriuretic peptide (NT-proBNP) level ≥500 pg/mL at screening.
• Able to provide signed written informed consent personally, or having a legally authorized representative who can provide consent on behalf of the participant.