A Randomized Comparison of Pulmonary Vein Isolation With Versus Without Concomitant Renal Artery Denervation in Patients With Refractory Symptomatic Atrial Fibrillation and Resistant Hypertension

Abstract

Renal artery denervation reduces systolic and diastolic blood pressure in patients with drug-resistant hypertension and reduces AF recurrences when combined with PVI.

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…In the future, novel approaches for ANS modulation could increase the efficacy of AF ablation treatment. 127,128,129 …”

“…279 Pooled analysis of two small studies demonstrated that renal artery denervation resulted in both sustained lowering of BP and reduction in AF recurrence postablation. 127,331 However, the antiarrhythmic effect of renal denervation is not well established, and whether it is mediated by remodeling of the hypertension-associated atrial substrate or decrease in neurohormonal activation remains uncertain. 129 Whereas upstream therapy with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers might be effective for primary prevention of AF in patients with systolic LV dysfunction or left ventricular hypertrophy, 332 their effect on secondary prevention postablation of AF is uncertain.…”

“…952,953 These types of continuous ECG monitoring devices have been used in several studies to evaluate the results of surgical or catheter AF ablation. 127,607,938,953,954,955,956,957,958,959,960,961 Although implantable subcutaneous monitors hold promise for the determination of AF burden in the long term, AF detection algorithms are primarily based on R-R interval regularity, and important limitations include reduced specificity due to undersensing of beats, oversensing of myopotentials, and irregular atrial and ventricular premature beats, as well as limited memory resulting in electrograms not being retrievable to verify the correct rhythm diagnosis. 941,944,962 Nevertheless, implantable continuous monitors can ameliorate patient compliance issues and provide an assessment of long-term AF burden and late recurrences, including asymptomatic episodes that might have implications for continuation of anticoagulation.…”

Renal Denervation for Ventricular Arrhythmia in Patients with Implantable Cardioverter Defibrillators

“…Early clinical evidence has suggested a possible benefit of RDN as an adjunct treatment option not just for VAs but for atrial fibrillation as well. 30,31) Study limitations: There are certain limitations in this study. First, norepinephrine spillover was not measured.…”

The effects of renal sympathetic denervation in the left atrium enlargement after pulmonary vein isolation

“…The perfect tactic for the handling of AF is rhythm control, but this is sometimes very hard to accomplish [3]. Pokushalov and colleagues [4] in recent times described that renal sympathetic denervation (RSD) reduces AF recurrences when joined with pulmonary vein isolation (PVI). Pointing of the pulmonary veins (PVs) and/or the PV antrum is the keystone for best AF ablation procedures.…”