Key result
Renal denervation as an adjunct to pulmonary vein isolation reduced the recurrence of atrial fibrillation by 57% compared to pulmonary vein isolation alone.
Why the study?
Recent studies support RDN for uncontrolled arterial hypertension, prompting an evaluation of its potential indications beyond blood pressure lowering, such as in atrial fibrillation.
Does renal denervation added to pulmonary vein isolation reduce the recurrence of atrial fibrillation in patients with AF and uncontrolled hypertension?
Does renal denervation added to pulmonary vein isolation reduce the recurrence of atrial fibrillation in patients with AF and uncontrolled hypertension?
Renal denervation combined with pulmonary vein isolation may significantly reduce atrial fibrillation recurrence, particularly in patients with uncontrolled hypertension.
Answers are grounded in this paper and cite their sources.
May support RDN reconsideration in resistant hypertension; leaves open guideline adoption pending higher-level evidence.
Renal denervation (RDN) is a therapeutic strategy for patients with uncontrolled arterial hypertension characterized by considerable fluctuations during its progression. After initial strong enthusiasm, the procedure came to an abrupt halt following the publication of the Symplicity HTN-3 study results. The results of recently published studies highlight the reduction in blood pressure values after RDN and justify the inclusion in the Guidelines of new recommendations for the use of RDN in clinical practice, in selected patients. Additionally, RDN findings are summarized in view of other potential indications such as atrial fibrillation. Six prospective, randomized studies are presented that evaluated RDN as an adjunct therapy to pulmonary vein isolation for the treatment of atrial fibrillation. In five studies, patients had uncontrolled hypertension despite therapy with three antihypertensive drugs. The analysis of these studies showed that RDN reduced the recurrence of atrial fibrillation (AF) by 57% compared to patients with pulmonary vein isolation (PVI) only. Modulation of the autonomic nervous system by RDN has been shown not only to reduce blood pressure but also to have an antiarrhythmic effect in symptomatic AF patients when the strategy is combined with PVI, thus opening up new therapeutic scenarios.
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Versaci et al. (2021) conducted a review in Atrial fibrillation and uncontrolled hypertension. Renal denervation (RDN) as an adjunct to pulmonary vein isolation (PVI) vs. Pulmonary vein isolation (PVI) only was evaluated on Recurrence of atrial fibrillation (AF) (57% reduction). Renal denervation as an adjunct to pulmonary vein isolation reduced the recurrence of atrial fibrillation by 57% compared to pulmonary vein isolation alone.
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