Electrocardiographic markers of arrhythmic risk after renal sympathetic denervation in resistant hypertension

OBJECTIVE: Renal sympathetic denervation (RDN) has emerged as a device-based therapy for resistant hypertension; however, its effects on electrocardiographic (ECG) markers related to arrhythmic risk remain incompletely defined. We aimed to evaluate changes in ECG indices reflecting atrial and ventricular electrical heterogeneity in patients undergoing RDN compared to medically treated controls. METHODS: This retrospective cohort study included 263 patients with resistant hypertension (RDN+, n = 120; RDN-, n = 143) with baseline and 6-month ECG recordings. ECG parameters included the P-wave dispersion, Tp-Te interval, and frontal QRS-T angle. To account for baseline differences, inverse probability of treatment weighting (IPW) based on propensity scores was applied. Weighted linear regression models with doubly robust adjustment were used to estimate the independent association between RDN and follow-up ECG parameters after adjusting for baseline ECG values and change in SBP. RESULTS: At 6 months, patients undergoing RDN demonstrated significantly lower P-wave dispersion (27.4 vs. 37.5 ms, P < 0.001), Tp-Te interval (80.3 vs. 84.7 ms, P = 0.028), and frontal QRS-T angle (26 vs. 37°, P = 0.026) compared with controls. In the weighted models, RDN remained independently associated with reductions in these parameters. CONCLUSION: In patients with resistant hypertension, renal sympathetic denervation was associated with improvements in ECG markers related to arrhythmic risk at 6 months, which were not fully explained by changes in office SBP.