Key result
Renal sympathetic denervation combined with pulmonary vein isolation significantly reduced the recurrence of atrial fibrillation to 32% compared to 56% with isolation alone (RR 0.60).
Why the study?
Data were limited on the effect of renal sympathectomy combined with pulmonary vein isolation in hypertensive patients with atrial fibrillation.
Does renal sympathetic denervation combined with pulmonary vein isolation reduce the recurrence of atrial fibrillation in patients with hypertension complicated with atrial fibrillation?
Meta-Analysis (n=734)
Does renal sympathetic denervation combined with pulmonary vein isolation reduce the recurrence of atrial fibrillation in patients with hypertension complicated with atrial fibrillation?
Relative Risk: 0.6 (95% CI 0.5–0.71)
Absolute Event Rate: 32% vs 56%
p-value: p=< 0.001
In patients with hypertension and paroxysmal atrial fibrillation, adding renal sympathetic denervation to pulmonary vein isolation significantly reduces AF recurrence and improves blood pressure control.
Supports adding renal sympathetic denervation to pulmonary vein isolation in hypertensive atrial fibrillation; confirms benefit across trials.
At present, there is limited data on the effect of renal sympathectomy combined with pulmonary vein isolation on hypertensive patients with atrial fibrillation. The purpose of this study was to explore the efficacy and safety of renal sympathectomy combined with ablation in the treatment of hypertension with atrial fibrillation. A comprehensive literature search was conducted on the treatment of hypertension complicated with atrial fibrillation. Comparing the clinical data of renal sympathetic denervation (RSDN)+pulmonary vein isolation (PVI) with that of PVI alone, we analyzed recurrence of postoperative atrial fibrillation (AF) as main outcome. Classification variables were represented by risk ratio (RR), continuous variables as average difference (MD) and 95% confidence interval (CI). A total of 7 eligible studies were included, including 734 patients (RSDN+PVI group: 340 cases; PVI group: 394 cases). The follow-up period was one year or more. Compared with the separate PVI (56%), the recurrence rate of AF in RSDN+PVI group (32%) decreased significantly (RR: 0.60, 95% CI: 0.50, 0.71, p < 0.001). RSDN+PVI increased the operation time (Weighted Mean Difference (WMD): 24.92, 95% CI: 20.27, 29.57, p < 0.001), but did not increase the fluoroscopy time (WMD: 1.58, 95% CI: −7.50, 10.66, p = 0.73). Six months after operation, the glomerular filtration rate in RSDN+PVI group was significantly higher than that in PVI group (WMD: 6.17, 95% CI: 3.09, 9.24, p < 0.001). The control of systolic blood pressure and diastolic blood pressure in RSDN+PVI group was significantly better than that in PVI group (WMD: −9.55, 95% CI: −16.27, −2.84, p = 0.005; WMD: −6.11, 95%CI: −10.72, −1.50, p = 0.009). There was no significant difference in complications between the two groups (RR: 0.85, 95% CI: 0.32, 2.21, p = 0.73). The heterogeneity of clinical outcome was very low in atrial fibrillation and complications (I2 = 0). PVI combined with RSDN is a feasible and safe interventional therapy option for patients with hypertension complicated with atrial fibrillation, which can effectively reduce the burden of atrial fibrillation and improve the control of blood pressure and prevent further renal damage.
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A 2022 study conducted a meta-analysis in Hypertension complicated with atrial fibrillation (n=734). Renal sympathetic denervation combined with pulmonary vein isolation vs. Pulmonary vein isolation alone was evaluated on Recurrence of postoperative atrial fibrillation (RR 0.60, 95% CI 0.50, 0.71, p=< 0.001). Renal sympathetic denervation combined with pulmonary vein isolation significantly reduced the recurrence of atrial fibrillation to 32% compared to 56% with isolation alone (RR 0.60).
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