Expanding the Targets of Renal Sympathetic Denervation: From Resistant Hypertension to Atrial Fibrillation

Atrial fibrillation is the most common cardiac arrhythmia affecting millions of people worldwide. Individuals with atrial fibrillation sustain significant morbidity mainly due to stroke while their mortality risk is twice higher in comparison to those with sinus rhythm. During the recent years radiofrequency ablation has become a standard procedure for the treatment of atrial fibrillation, albeit with moderate efficacy. Among the risk factors of atrial fibrillation, hypertension has a prominent role. Recently Renal Sympathetic Denervation has been proposed as an effective way to control resistant hypertension showing a sustained reduction in blood pressure. Increased sympathetic activity seems necessary to induce and sustain atrial fibrillation. It can also be considered as one of the common pathways connecting hypertension with atrial fibrillation. Given the limitations of the conventional treatment of atrial fibrillation, Renal Sympathetic Denervation has been proposed as a new treatment modality for the management of this common arrhythmia. Hard data are still lacking but the early results are very promising. Two randomized trials are currently conducted and are expected to answer the question whether the targets of Renal Sympathetic Denervation can expand beyond the treatment of resistant hypertension.