A Randomized Comparison of Pulmonary Vein Isolation With Versus Without Concomitant Renal Artery Denervation in Patients With Refractory Symptomatic Atrial Fibrillation and Resistant Hypertension
What is impact of renal denervation (RDN) on reoccurrence of atrial fibrillation (AF) in patients undergoing pulmonary vein isolation (PVI)?
The authors enrolled patients with a history of symptomatic paroxysmal or persistent AF refractory to two or more antiarrhythmic drugs and drug-resistant hypertension (systolic blood pressure >160 mm Hg despite triple drug therapy) and randomized them to PVI only or PVI with RDN. All patients were followed for 1 year to assess maintenance of sinus rhythm and to monitor changes in blood pressure.
The study enrolled a total of 27 patients, of whom 14 were randomized to PVI only, and 13 were randomized to PVI with renal artery denervation. Patients treated with RDN had a significant decline in systolic (from 181 ± 7 to 156 ± 5 mm Hg, p < 0.001) and diastolic blood pressure (from 97 ± 6 to 87 ± 4, p < 0.001) at follow-up, while no significant change was observed in the PVI-only group. Nine of the 13 patients (69%) treated with PVI with RDN were AF-free at the 12-month post-ablation follow-up examination compared with 4 (29%) of the 14 patients in the PVI-only group (p = 0.033).
The authors concluded that renal artery denervation performed in combination with PVI was associated with a reduction in blood pressure and AF recurrence.
RDN has demonstrated marked efficacy in patients with resistant hypertension. This small study demonstrates a reduction in recurrence of AF with RDN in patients undergoing PVI. The procedure was performed in the same setting as PVI, using the same equipment, and is likely to be extremely cost-effective. These provocative findings invoke the need for an adequately powered study to define the clinical role of RDN in patients undergoing PVI for AF.
Keywords: Blood Coagulation, Follow-Up Studies, Denervation, Pulmonary Veins, Blood Pressure, Neurosurgical Procedures, Catheter Ablation, Hypertension
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