Renal denervation plus cardiac ablation vs. cardiac ablation alone for patients with atrial fibrillation and uncontrolled arterial hypertension A systematic review and updated meta-analysis of randomized controlled trials

• Published in: Herz Vol. 50; no. 4; pp. 277 - 286
• Main Authors: Gonçalves, Ocílio Ribeiro, de Melo Neto, Altair Pereira, Machado Pereira, Maria Antonia Oliveira, Ohannesian, Victor Arthur, Fernandes, Matheus Augusto Nepomuceno, Dantas, Clara Rocha, Camarotti, Maria Tereza, de Oliveira, João Victor Araújo, Sanchez, Gustavo José Silva, de Lima, Carlos Eduardo Batista, da Silva, Avelar Alves
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer Medizin 01.08.2025
• Subjects: Atrial Fibrillation - complications; Atrial Fibrillation - surgery; Atrial Fibrillation - therapy; Cardiology; Catheter Ablation - methods; Combined Modality Therapy; Denervation - methods; Female; Humans; Hypertension - complications; Hypertension - surgery; Internal Medicine; Kidney - innervation; Male; Medicine; Medicine & Public Health; Randomized Controlled Trials as Topic; Review Articles; Treatment Outcome; Renal denervation; Hypertension; Renale Denervation; Cardiac ablation; Atrial fibrillation; Bluthochdruck; Kardiale Ablation; Metaanalyse; Vorhofflimmern; Meta-analysis
• ISSN: 0340-9937; 1615-6692; 1615-6692
• DOI: 10.1007/s00059-025-05302-4

Background Atrial fibrillation (AF) is a complex arrhythmia often worsened by hypertension (HTN). Pharmacological treatments frequently underperform, and the best approach, particularly combining renal denervation (RDN) with cardiac ablation (CA), remains unclear. Objective We conducted an updated meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy of RDN combined with CA versus CA alone in patients with AF and uncontrolled HTN. Methods We performed a systematic review and meta-analysis of RCTs retrieved from PubMed, Embase, and the Cochrane Library up to July 2024. Primary outcomes included AF recurrence, periprocedural complications, blood pressure changes, and estimated glomerular filtration rate (eGFR). Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were computed using a random-effects model. Results Eight RCTs were included, involving 689 patients (37% female). Of these, 355 underwent RDN + CA, and 334 underwent CA alone, with a mean follow-up of at least 12 months. The RDN + CA group exhibited a significant reduction in AF recurrence (RR: 0.77; 95% CI: 0.61–0.97). There were no significant differences in periprocedural complications (RR: 1.06; 95% CI: 0.60–1.89), systolic blood pressure (MD: −6.79; 95% CI: −14.71–1.14), diastolic blood pressure (MD: −2.47; 95% CI: −8.13–3.20), or eGFR (MD: 1.14; 95% CI: −11.95–14.23). Conclusion Our findings show that RDN combined with CA significantly reduces AF recurrence compared to CA alone, presenting a promising approach for patients with resistant HTN and AF.