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Background: Targeted lung denervation (TLD) is a novel bronchoscopic therapy that disrupts parasympathetic pulmonary nerve input to the lung. Parasympathetic input to the heart originating from the lungs contributes to respiratory sinus arrhythmia (RSA) and disruption of pulmonary nerves via TLD may impact RSA. Objective: The aim of this study was to assess the potential of TLD to affect RSA in sheep and humans. Methods: TLD was performed in 5 sheep and 9 humans using a novel lung denervation system (Nu­vaira Inc., Minneapolis, MN, USA) with an electrocardiogram collected before and after the procedure. Frequency domain analysis of heart rate variability was performed in 5 sheep and 6 humans with presence of RSA approximated as high-frequency power (HF power). Results: HF power decreased in 3 of 5 sheep with 1 animal reaching less than 7% of its baseline HF power 30 days after TLD. The average treatment location was more distal in the remaining 2 animals, which did not exhibit RSA attenuation, suggesting diminished denervation. HF power decreased in 5 of 6 humans, with 3 subjects reaching less than 50% of their baseline HF power 90 days after TLD. Conclusions: TLD appeared to attenuate RSA in both sheep and human cohorts of this sub-study. Further confirmation in humans is necessary to allow for RSA attenuation to be used as a marker of successful lung denervation via TLD.

Arschang Valipour,1 Sherwin Asadi,1 Christophe Pison,2 Marie Jondot,2 Romain Kessler,3 Khaled Benneddif,3 Gaetan Deslee,4 Margaux Verdier,4 Dirk-Jan Slebos,5 Martin Mayse6 1Department of Respiratory and Critical Care Medicine, Ludwig-Boltzmann-Institute for COPD and Respiratory Epidemiology, Otto-Wagner-Spital, Vienna, Austria; 2CHU Grenoble Alpes, Clinique Universitaire de Pneumologie, Université Grenoble Alpes, Grenoble, France; 3Service de Pneumologie, Nouvel Hôpital Civil, Université de Strasbourg, Strasbourg, France; 4CHU de Reims, Hôpital Maison Blanche, Service de Pneumologie, INSERM UMRS903, Reims, France; 5Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; 6Nuvaira, Inc., Minneapolis, MN, USA Background: Targeted lung denervation (TLD) is a novel bronchoscopic therapy for COPD which ablates parasympathetic pulmonary nerves running along the outside of the two main bronchi with the intent of inducing permanent bronchodilation. The goal of this study was to evaluate the feasibility and long-term safety of bilateral TLD during a single procedure. Patients and methods: This prospective, multicenter study evaluated 15 patients with moderate-to-severe COPD (forced expiratory volume in 1s [FEV1] 30%–60%) who underwent bilateral TLD treatment following baseline assessment without bronchodilators. The primary safety end point was freedom from documented and sustained worsening of COPD directly attributable to TLD up to 1 year. Secondary end points included technical feasibility, change in pulmonary function tests, exercise capacity, and health-related quality of life. Follow-up continued up to 3years for subjects who reconsented for longer-term follow-up. Results: A total of 15 patients (47% male, age 63.2±4.0 years) underwent TLD with a total procedure time of 89±16min, and the total fluoroscopy time was 2.5±2.7min. Primary safety end point of freedom from worsening of COPD was 100%. There were no procedural complications reported. Results of lung function analysis and exercise capacity demonstrated similar beneficial effects of TLD without bronchodilators, when compared with long-acting anticholinergic therapy at 30days, 180days, 365days, 2 years, and 3years post-TLD. Five of the 12 serious adverse events that were reported through 3 years of follow-up were respiratory related with no events being related to TLD therapy. Conclusion: TLD delivered to both lungs in a single procedure is feasible and safe with few respiratory-related adverse events through 3 years. Keywords: COPD, bronchoscopy, radiofrequency ablation, denervation, device

Background: The success of intrabronchial valve treatment (IBV) for emphysema depends on appropriate patient selection. Methods: Single-center, prospective study of patients with severe, symptomatic emphysema despite optimal medical treatment. Only patients with evidence of a target lobe with ≥ 40% emphysema destruction, ≥ 15% point difference compared with the ipsilateral lobe, and ≥ 90% complete interlobar fissures were considered eligible. Computed lung tomography, lung function, and symptoms were recorded at baseline and at 3 months post valve treatment. Results: 144 patients with moderate-to-severe COPD underwent eligibility assessment. Out of these, 23 (17% of total) fulfilled the radiological criteria for valve treatment. Data on 19 patients with full data available at 3 months post valve treatment are presented. Patients treated had a mean±SD age of 65±7 yrs, FEV1 26±6% predicted, Residual Volume 307±67%, and a baseline SGRQ of 57±17. 15 out of 19 patients received lower lobe treatment. There were statistically significant improvements in FEV1 (+90±117ml), residual volume (- 540±750ml), and SGRQ (-7.2±13.7) at 3 months post valve treatment (p Conclusions: Intrabronchial lobar valve treatment in patients with heterogeneous emphysema and complete interlobar fissures is associated with favourable clinical outcomes with acceptable safety.