Renal denervation for improving outcomes of catheter ablation in patients with atrial fibrillation and hypertension: Early experience

• Published in: Heart rhythm Vol. 11; no. 7; pp. 1131 - 1138
• Main Authors: Pokushalov, Evgeny, MD, PhD, Romanov, Alexander, MD, Katritsis, Demosthenes G., MD, PhD, Artyomenko, Sergey, MD, Bayramova, Sevda, MD, Losik, Denis, MD, Baranova, Vera, MD, Karaskov, Alexander, MD, PhD, Steinberg, Jonathan S., MD, FHRS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2014
• Subjects: Ablation; Adult; Aged; Atrial fibrillation; Atrial Fibrillation - complications; Atrial Fibrillation - surgery; Blood Pressure; Cardiovascular; Catheter Ablation - adverse effects; Catheter Ablation - methods; Female; Follow-Up Studies; Humans; Hypertension - complications; Hypertension - surgery; Male; Middle Aged; Pulmonary Veins - surgery; Recurrence; Renal Artery - innervation; Renal denervation; Resistant hypertension; Survival Analysis; Sympathectomy - adverse effects; Sympathectomy - methods; Sympathetic Nervous System - physiology; Treatment Outcome; Renal denervation; PVI; Resistant hypertension; AF; CI; PV; radiofrequency; ECG; paroxysmal atrial fibrillation; HR; high-frequency stimulation; pulmonary vein isolation; Ablation; electrocardiography; atrial fibrillation; HFS; PAF; RF; hazard ratio; pulmonary vein; confidence interval; Atrial fibrillation
• ISSN: 1547-5271; 1556-3871
• DOI: 10.1016/j.hrthm.2014.03.055

Background The potential role of renal denervation (RD) in patients with AF and less severe hypertension is unknown. Objective The purpose of this study was to assess the potential role of RD as an adjunct to pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF) and moderate resistant or severe resistant hypertension. Methods The data for this study were obtained from 2 different prospective randomized studies, analyzed by meta-analysis. Patients with paroxysmal AF or persistent AF and moderate resistant hypertension (office blood pressure BP ≥140/90 mm Hg and <160/100 mm Hg; first study; n = 48) or severe resistant hypertension (≥160/100 mm Hg; second study; n = 38) were randomized to PVI or PVI with RD. Results At 12 months, 26 of the 41 PVI with RD patients (63%) were AF-free vs 16 of the 39 patients (41%) in the PVI-only group ( P = .014). In patients with severe hypertension, 11 of the 18 PVI with RD patients (61%) vs 5 of the 18 PVI-only patients (28%) were AF-free ( P = .03). For moderate hypertension, the differences were less dramatic: 11 of 21 (52%) vs 15 of 23 (65%) when RD added ( P = .19). The superior efficacy of adding RD was most apparent in persistent AF and severe hypertension (hazard ratio 0.25, confidence interval 0.09–0.72, P = .01). Duration of the procedure and fluoroscopy were nonsignificantly longer in the RD group. Conclusion RD may improve the results of PVI in patients with persistent AF and/or severe resistant hypertension.