The Effects of Renal Denervation Combined with Pulmonary Vein Isolation in Patients with Atrial Fibrillation: a Systematic Review and Meta-analysis of Randomized Controlled Trials

Background: Activity of autonomic nerve plays a critical role in the initiation and sustainability of atrial fibrillation (AF). Renal denervation (RDN) can significantly reduce systemic sympathetic tone. Our study aimed to explore the effect of RDN on the improvement of AF recurrence after pulmonary vein isolation (PVI). Methods and Results: We searched PubMed, EMBase and the Cochrane Library for randomized controlled trials (RCT). The primary endpoint was AF recurrence at 1-year follow-up. The second endpoint included changes of blood pressure; renal function; left atrial diameter at 1-year follow-up. Four RCTs involving 496 patients were included in our meta-analysis. Compared to PVI alone, RDN combined with PVI could significantly reduce the recurrence of AF (OR, 0.37; 95% CI, 0.22 to 0.62, p<0.001); significantly lowered both systolic and diastolic BP (SBP: SMD,-1.30; 95%CI: -2.10 to -0.50; p=0.001; DBP: SMD,-0.99; 95%CI: -1.51 to -0.48; p<0.001); improved eGFR (MD,13.95 mL/min/1.73m2; 95%CI: 6.41 to 21.49 mL/min/1.73m2; p<0.001); numerically reduced left atrial diameter (MD, -2.10mm; 95%CI: -4.61 to 0.42mm; p=0.10) at 12-month follw-up. Subgroup analysis showed more improvement on AF recurrence in patients with persistent AF compared with paroxysmal AF (OR, 0.17 vs. 0.48; Pinteraction=0.05). No renal artery complications were reported. Conclusion: RDN is a safe and efficient procedure. RDN in addition to PVI, is associated with reduced AF recurrence; better controlled blood pressure and improved eGFR compared to PVI alone at 12-month follow-up. The reduction of AF recurrence might be more remarkable in patients with persistent AF.