ReviewThe Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology2026
Endovascular ablation of the right greater splanchnic nerve for the management of heart failure with preserved ejection fraction: a systematic review and meta-analysis.
Review in The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundHeart failure with preserved ejection fraction (HFpEF) remains difficult to manage because conventional therapies often provide limited symptom relief and do not adequately address exercise-related congestion. Right greater splanchnic nerve (GSN) ablation has emerged as a potential therapeutic approach by modulating splanchnic venous capacitance. However, current evidence is limited and includes both uncontrolled and randomized studies.
methodsWe performed a systematic review and meta-analysis of studies evaluating right GSN ablation in HFpEF. Searches were conducted in PubMed, Scopus, and Embase in December 2024. Randomized and non-randomized studies were included. Continuous outcomes were pooled as mean differences (MDs) with 95% confidence intervals (CIs). Sensitivity analyses excluding the randomized controlled trial (RCT) were performed for selected outcomes. Analyses based on uncontrolled studies and converted median/interquartile range data were considered exploratory.
resultsThe most consistent findings were observed in functional and exercise-related hemodynamic outcomes. Six-minute walk distance improved at both 6 and 12 months, and KCCQ overall score showed improvement, although with substantial heterogeneity. Provocative hemodynamic measures, including 20 W and peak pulmonary capillary wedge pressure, were reduced at 1 month, whereas resting hemodynamic measures showed no clear pooled benefit. NT-proBNP, renal indices, blood pressure, heart rate, and left ventricular ejection fraction were largely unchanged. Overall, randomized sham-controlled evidence did not demonstrate a clear comparative benefit.
conclusionsRight GSN ablation may improve selected exercise-related hemodynamic, functional, and patient-reported outcomes in HFpEF, but the current evidence base is driven mainly by small uncontrolled studies. Randomized evidence remains neutral, and further sham-controlled trials are required.
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