Combined renal denervation and pulmonary vein isolation significantly reduced atrial fibrillation recurrence to 31.3% compared to 52.9% with pulmonary vein isolation alone in hypertensive patients.
Meta-Analysis (n=711)
Does adding renal denervation to pulmonary vein isolation reduce atrial fibrillation recurrence in hypertensive patients with AF?
Adding renal denervation to pulmonary vein isolation significantly reduces atrial fibrillation recurrence and improves systolic blood pressure and eGFR in hypertensive patients with AF.
Absolute Event Rate: 31.3% vs 52.9%
p-value: p=<0.00001
Abstract The study aims to compare clinical outcomes following renal denervation (RDN) in hypertensive patients with atrial fibrillation (AF). Three online databases were searched (MEDLINE, EMBASE and PubMed) for literature related to outcomes of RDN on hypertension and AF, between January 1, 2010, and June 1, 2021. Where possible, risk ratios (RR) and mean differences (MD) were combined using a random effects model. Significance was set at p ≤ 0.05. Seven trials were included that assessed the effect of adding RDN to pulmonary vein isolation (PVI) in patients with hypertension and AF. A total of 711 patients (329 undergoing PVI + RDN and 382 undergoing PVI alone), with an age range of 56 ± 6 to 68 ± 9 years, were included. Pooled analysis showed a significant lowering of AF recurrence in the PVI + RDN (31.3%) group compared to the PVI-only (52.9%) group ( p < 0.00001). Pooled analysis of patients with resistant hypertension showed a significant mean reduction of systolic blood pressure (SBP) (−9.42 mm Hg, p = 0.05), but not diastolic blood pressure (DBP) (−4.11 mm Hg, p = 0.16) in favor of PVI + RDN. Additionally, the pooled analysis showed that PVI + RDN significantly improved estimated glomerular filtration rate (eGFR) (+10.2 mL/min per 1.73 m 2 , p < 0.001) compared to PVI alone. RDN procedures in these trials have proven to be both safe and efficacious with an overall complication rate of 6.32%. Combined PVI and RDN is beneficial for patients with hypertension and AF. Combined therapy showed improvement in SBP and eGFR, reducing the risk of AF recurrence. RDN may serve as an innovative intervention in the treatment of AF.
Nawar et al. (Sat,) conducted a meta-analysis in Hypertension and Atrial Fibrillation (n=711). Renal denervation (RDN) + Pulmonary vein isolation (PVI) vs. Pulmonary vein isolation (PVI) alone was evaluated on Atrial fibrillation recurrence (p=<0.00001). Combined renal denervation and pulmonary vein isolation significantly reduced atrial fibrillation recurrence to 31.3% compared to 52.9% with pulmonary vein isolation alone in hypertensive patients.