Effect of combined renal denervation and pulmonary vein isolation in atrial fibrillation recurrence in hypertensive patients: A meta‐analysis

Abstract

Background: Atrial Fibrillation (AF) is the most common cardiac arrhythmia and hypertension is the most common risk factor associated with AF. The addition of renal sympathetic nerve denervation (RSDN) to pulmonary vein isolation (PVI) in AF patients with hypertension has been reported to improve clinical outcomes. Methods: A systematic search was performed for studies on patients with AF and hypertension that compared RSDN with PVI versus PVI-alone. Risk ratio (RR) for categorical variables and mean difference (MD) for continuous variables with 95% confidence intervals were used. Results: Seven studies with a total of 734 patients were included. A total of 340 patients were in the RSDN + PVI group (46.32%) and 394 (53.67%) in the PVI group. A total of 608 patients had paroxysmal AF (83%) while 126 patients had persistent AF (17%). At 12 months follow-up, RSDN + PVI decreased the overall risk of AF recurrence in hypertensive patients with RR 0.60 [95% CI 0.50-0.72, P < .00001]. A subgroup analysis performed in patients with drug-resistant hypertension showed a similar reduction in AF recurrence with RR 0.61 [95% CI: 0.47-0.79, P = .0002). Procedure duration MD + 28.05 min [95% CI: 18.88-37.23, P < .00001] and fluoroscopy duration MD + 5.59 min [95% CI: 3.31-8.19, P < .00001] were significantly longer with the RSDN + PVI group. There was no significant difference in complications between the two groups. Conclusion: The addition of RSDN to PVI in patients with AF and hypertension appears safe and decreases AF recurrence. Similar results were observed in patients with drugresistant hypertension. Larger trials are needed to confirm these results.

Systematic review of renal denervation for the management of cardiac arrhythmias

“…This systematic review has several limitations that stem from the quality of studies included. (1) The review included a large number of unblinded, non-randomised observational studies. Data extracted from these cohort studies are potentially affected by biases due to the study design such as selection bias and allocation bias.…”

“…We included studies that were (1) original research study, i.e. randomised controlled trial (RCT) or non-randomised observational studies (retrospective or prospective cohort), (2) studied a human population with any form of cardiac arrhythmia, (3) had a treatment arm where RSD was used, (4) reported outcomes as follows: arrhythmia (atrial or ventricular) recurrence, changes in blood pressure, change in heart rate, mortality, hospitalisation, complications (general or procedural), renal function and cardiac morphological changes (echocardiographic parameters).…”

“…All studies, whether RSD alone or RSD with PVI, report a significant (p < 0.05) or marked numerical decrease in AF recurrence, or a higher number of patients that are AF free in the treatment arm that includes RSD as opposed to the control group [25][26][27][28][29][30][31][32]. In addition to freedom from AF, Steinberg et al [1] reported freedom from atrial flutter and tachycardia at 12 months that was significantly higher in the RSD treatment group (p = 0.006).…”

“…Cardiac arrhythmias contribute significantly to morbidity and mortality worldwide [ 1 , 2 ]. Atrial arrhythmias are the commonest arrhythmias observed in clinical practice with an increasing prevalence due partly to an ageing population, with atrial fibrillation (AF) alone affecting 33.5 million people globally [ 1 ]. AF is additionally linked with strokes which can be highly debilitating [ 3 , 4 ].…”

Influence on the autonomic cardiovascular system regulation in the treatment of hypertension, arrhythmias and heart failure

“…Наряду со снижением парасимпатических влияний, коррекция гиперсимпатикотонии также была предложена в качестве фактора, снижающего вероятность рецидивов ФП после катетерной изоляции легочных вен. Предлагалось выполнение ренальной денервации в дополнение к катетерной изоляции легочных вен, что в одноцентровых исследованиях было ассоциировано как со снижением АД у лиц с гипертензией, так и меньшей частотой возобновления ФП [68]. К сожалению, в недавнем многоцентровом исследовании показаны нейтральные результаты дополнительной ренальной денервации в лечении ФП [69].…”