Efficacy and safety of renal denervation in addition to pulmonary vein isolation for atrial fibrillation and hypertension—Systematic review and meta‐analysis of randomized controlled trials

Pranata, Raymond; Vania, Rachel; Raharjo, Sunu Budhi

doi:10.1002/joa3.12353

Cited by 8 publications

(6 citation statements)

References 27 publications

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“…Despite recent advances in procedures and technology, AF recurrence after catheter ablation occurs in approximately 30 to 60% of the patients. [3][4][5][6][7][8][9] Managing risk factors and being able to optimize the rhythm control in these patients are of great interest. 10,11 Obesity is a growing pandemic and has affected approximately a third of world population, doubled compared to the 1980s.…”

Section: Introductionmentioning

confidence: 99%

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BMI and atrial fibrillation recurrence post catheter ablation: A dose‐response meta‐analysis

Pranata

Henrina²,

Yonas

et al. 2021

Eur J Clin Investigation

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Introduction:The evidence on the association between obesity and atrial fibrillation (AF) recurrence was equivocal. We aimed to evaluate the dose-response relationship between body mass index (BMI) and AF recurrence and adverse events. Methods: A systematic literature search was conducted using PubMed, Europe PMC, EBSCO, ProQuest and Cochrane Library. Obesity was defined as BMI ≥28 kg/m 2 . The primary outcome was AF recurrence, and the secondary outcome was adverse events. Adverse events were defined as procedure-related complications and cardiocerebrovascular events. Results: There were a total of 52,771 patients from 20 studies. Obesity was associated with higher AF recurrence (Odds ratio [OR] 1.30 [95% confidence interval [CI] 1.16-1.47], P < .001; I 2 : 72.7%) and similar rate of adverse events (OR 1.21 [95% CI 0.87-1.67], P = .264; I 2 : 23.9%). Meta-regression showed that the association varies by age (coefficient: −0.03, P = .024). Meta-analysis of highest versus lowest BMI showed that the highest group had higher AF recurrence (OR 1.37 [95% CI 1.18-1.58], P < .001; I 2 : 64.9%) and adverse events (OR 2.02 [95% CI 1.08-3.76], P = .028; I 2 : 49.5%). The linear association analysis for AF recurrence was not significant (P = .544). The dose-response relationship for BMI and AF recurrence was nonlinear (p nonlinearity < 0.001), the curve became steeper at 30-35 kg/m 2 . For adverse events, an increase of 1% for every 1 kg/m 2 increase in BMI (OR 1.01 [95% CI 1.00-1.02], P = .001), the relationship was nonlinear (p nonlinearity = 0.001). Conclusion: Obesity was associated with higher AF recurrence in patients undergoing catheter ablation. High BMI might be associated with a higher risk for adverse events.

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Section: Introductionmentioning

confidence: 99%

“…Catheter ablation has become one of the mainstay modalities to treat AF. Despite recent advances in procedures and technology, AF recurrence after catheter ablation occurs in approximately 30 to 60% of the patients 3‐9 . Managing risk factors and being able to optimize the rhythm control in these patients are of great interest 10,11 …”

Section: Introductionmentioning

confidence: 99%

BMI and atrial fibrillation recurrence post catheter ablation: A dose‐response meta‐analysis

Pranata

Henrina²,

Yonas

et al. 2021

Eur J Clin Investigation

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“…This result is in accordance with the results of other meta-analyses. 25,26 But they all enrolled the studies Pokushalov 2012, 10 Pokushalov 2014, 11 Romanov 2016 12 together, which included overlapping data, for pooled analysis. Thus, the heterogeneities might be underestimated and the results might be biased in these meta-analyses.…”

Section: Discussionmentioning

confidence: 99%

The Effects of Renal Denervation Combined with Pulmonary Vein Isolation in Patients with Atrial Fibrillation: a Systematic Review and Meta-analysis of Randomized Controlled Trials

Geng,

Qi,

et al. 2024

Preprint

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Background: Activity of autonomic nerve plays a critical role in the initiation and sustainability of atrial fibrillation (AF). Renal denervation (RDN) can significantly reduce systemic sympathetic tone. Our study aimed to explore the effect of RDN on the improvement of AF recurrence after pulmonary vein isolation (PVI). Methods and Results: We searched PubMed, EMBase and the Cochrane Library for randomized controlled trials (RCT). The primary endpoint was AF recurrence at 1-year follow-up. The second endpoint included changes of blood pressure; renal function; left atrial diameter at 1-year follow-up. Four RCTs involving 496 patients were included in our meta-analysis. Compared to PVI alone, RDN combined with PVI could significantly reduce the recurrence of AF (OR, 0.37; 95% CI, 0.22 to 0.62, p<0.001); significantly lowered both systolic and diastolic BP (SBP: SMD,-1.30; 95%CI: -2.10 to -0.50; p=0.001; DBP: SMD,-0.99; 95%CI: -1.51 to -0.48; p<0.001); improved eGFR (MD,13.95 mL/min/1.73m2; 95%CI: 6.41 to 21.49 mL/min/1.73m2; p<0.001); numerically reduced left atrial diameter (MD, -2.10mm; 95%CI: -4.61 to 0.42mm; p=0.10) at 12-month follw-up. Subgroup analysis showed more improvement on AF recurrence in patients with persistent AF compared with paroxysmal AF (OR, 0.17 vs. 0.48; Pinteraction=0.05). No renal artery complications were reported. Conclusion: RDN is a safe and efficient procedure. RDN in addition to PVI, is associated with reduced AF recurrence; better controlled blood pressure and improved eGFR compared to PVI alone at 12-month follow-up. The reduction of AF recurrence might be more remarkable in patients with persistent AF.

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“…Pulmonary vein isolation (PVI) is used widely to treat symptomatic AF; however, its success rate is not optimal and there is a marked recurrence rate of arrhythmia is certain subgroup of patients. However, with the addition of RSD to PVI, the results of several RCTs and meta-analysis seem promising with regards to lowering the rate of AF recurrence significantly [ 11 , 30 , 57 ]. Studies have reported a role for RSD in other atrial and ventricular arrhythmia subtypes, and the majority of studies here demonstrate reduced ventricular arrhythmias.…”

Section: Discussionmentioning

confidence: 99%

“…Renal sympathetic denervation (RSD) was first performed in 1925 [ 8 ], but due to its inability to reduce blood pressure safely as well as effectively in patients with resistant hypertension, did not gain significant attention until the recent consequential findings of the HTN-1 [ 9 ] and HTN-2 [ 10 ] trials. Given that hypertension is one of the most important risk factors for developing AF and its recurrence [ 11 ], there has been speculation that RSD may reduce AF burden [ 12 , 13 ]. Whilst this may be a direct consequence of BP reduction, there is some evidence that the impact of RSD on cardiac arrhythmias may be independent of BP effects [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Systematic review of renal denervation for the management of cardiac arrhythmias

et al. 2021

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Background In the wake of the controversy surrounding the SYMPLICITY HTN-3 trial and data from subsequent trials, this review aims to perform an updated and more comprehensive review of the impact of renal sympathetic denervation on cardiac arrhythmias. Methods and results A systematic search was performed using the Medline, Scopus and Embase databases using the terms “Renal Denervation” AND “Arrhythmias or Atrial or Ventricular”, limited to Human and English language studies within the last 10 years. This search yielded 19 relevant studies (n = 6 randomised controlled trials, n = 13 non-randomised cohort studies) which comprised 783 patients. The studies show RSD is a safe procedure, not associated with increases in complications or mortality post-procedure. Importantly, there is no evidence RSD is associated with a deterioration in renal function, even in patients with chronic kidney disease. RSD with or without adjunctive pulmonary vein isolation (PVI) is associated with improvements in freedom from atrial fibrillation (AF), premature atrial complexes (PACs), ventricular arrhythmias and other echocardiographic parameters. Significant reductions in ambulatory and office blood pressure were also observed in the majority of studies. Conclusion This review provides evidence based on original research that ‘second generation’ RSD is safe and is associated with reductions in short-term blood pressure and AF burden. However, the authors cannot draw firm conclusions with regards to less prominent arrhythmia subtypes due to the paucity of evidence available. Large multi-centre RCTs investigating the role of RSD are necessary to comprehensively assess the efficacy of the procedure treating various arrhythmias. Graphic abstract

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Efficacy and safety of renal denervation in addition to pulmonary vein isolation for atrial fibrillation and hypertension—Systematic review and meta‐analysis of randomized controlled trials

Cited by 8 publications

References 27 publications

BMI and atrial fibrillation recurrence post catheter ablation: A dose‐response meta‐analysis

BMI and atrial fibrillation recurrence post catheter ablation: A dose‐response meta‐analysis

The Effects of Renal Denervation Combined with Pulmonary Vein Isolation in Patients with Atrial Fibrillation: a Systematic Review and Meta-analysis of Randomized Controlled Trials

Systematic review of renal denervation for the management of cardiac arrhythmias

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