Atrial fibrillation reduction by renal sympathetic denervation: 12 months’ results of the AFFORD study

Abstract

Aim The purpose of this pilot study was to assess whether renal sympathetic denervation (RDN) decreases atrial fibrillation (AF) burden in hypertensive patients with symptomatic AF at 6- and 12-month follow-up, as measured using an implantable cardiac monitor (ICM). Methods and results A total of 20 patients with symptomatic paroxysmal or persistent AF (EHRA ≥ II) and primary hypertension with a mean office systolic blood pressure (BP) of > 140 mmHg were enrolled. After enrolment, an ICM was implanted 3 months pre-RDN to monitor AF burden. Quality of life (QOL) was assessed using the Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) questionnaire. Mean age was 64 ± 7 years and 55% were females. AF burden in min/day decreased from a median (IQR) of 1.39 (0–11) pre-RDN to 0.67 (0–31.6) at 6 months ( p = 0.64) and to 0.94 (0–6.0) at 12 months (pre-RDN vs. 12 months; p = 0.03). QOL improved significantly at both 6 months (+ 11 ± 15 points, p = 0.006) and 12 months (+ 10 ± 19, p = 0.04) as compared to pre-RDN. Office BP decreased significantly at 12-month follow-up (− 20 ± 19/− 7 ± 10 mmHg), p < 0.01) as compared to pre-RDN. Ambulatory BP decreased − 7 ± 16/− 3 ± 9 mmHg ( p > 0.05) at 12-month follow-up as compared to pre-RDN. Conclusion This pilot study suggests that RDN might be able to decrease AF burden in min/day as measured using an ICM, with a positive effect on QOL. Large-scale randomized trials are needed to prove the definite value of RDN in hypertensive patients with atrial fibrillation. Electronic supplementary material The online version of this article (10.1007/s00392-018-1391-3) contains supplementary material, which is available to authorized users.

Sympathetic Nervous System Activation and Its Modulation: Role in Atrial Fibrillation

“…Recently, the AFFORD study, a single-arm pilot study including 20 patients with symptomatic paroxysmal or persistent AF, suggested that RDN alone was safe and able to decrease AF burden in min/day as measured using an implantable cardiac monitor (ICM) at 12-month follow-up accompanied by an improvement in quality of life (Feyz et al, 2018). A clinical study that assessed the antiarrhythmic effect of RDN in addition to pulmonary vein isolation (PVI) in HTN patients with symptomatic AF demonstrated that a mean BP reduction of 5–10 mmHg led to a 7% decrease in AF burden as measured with an ICM (Romanov et al, 2017).…”

Efficacy and safety of renal denervation in addition to pulmonary vein isolation for atrial fibrillation and hypertension—Systematic review and meta‐analysis of randomized controlled trials

“…RDN has been though to reduce sympathetic overactivity and arrhythmogenic foci/substrate arising from it 12 . RDN alone without PVI has been shown to reduce AF burden and increase the quality of life in patients with AF 11 . Furthermore, RDN in PVI patients was shown to reduce left ventricular septal thickness and posterior wall thickness 13,16 .…”

“…Renal denervation (RDN) may attenuate the hyperactive sympathetic nervous system which in turn leads to a reduction in RAAS activation and lowering of blood pressure 9,10 . RDN with or without PVI has been shown to reduce AF burden in hypertensive patients 11,12 …”

Neuromodulation for the Treatment of Heart Rhythm Disorders

“…As a stand-alone therapy, RDN may also promote reverse-remodeling and improve atrial substrate. A pilot trial of 20 patients with paroxysmal or persistent AF and hypertension showed that RDN reduced AF burden and improved quality of life (54). Moreover, RDN reduced atrial conduction time, complex fractionated atrial activity, and ventricular mass in 14 patients with treatment-resistant hypertension (55).…”