Pulmonary vein isolation alone and combined with renal sympathetic denervation in chronic kidney disease patients with refractory atrial fibrillation

Abstract

BackgroundAtrial fibrillation (AF) commonly occurs in association with chronic kidney disease (CKD), resulting in adverse outcomes. Combining pulmonary vein isolation (PVI) and renal sympathetic denervation (RSD) may reduce the recurrence of AF in patients with CKD and hypertension. We considered that RSD could reduce the recurrence of AF in patients with CKD by modulating sympathetic hyperactivity. Our goal was to compare the impact of PVI + RSD with that of PVI alone in patients with concurrent AF and CKD.MethodsThis was a single-center, prospective, longitudinal, randomized, double-blind study. Forty-five patients with controlled hypertension, symptomatic paroxysmal AF and/or persistent AF, stage 2 or 3 CKD, and a dual-chamber pacemaker were enrolled from January 2014 to January 2015. We assessed the 30-second recurrence of AF recorded by the pacemaker, 24-hour ambulatory blood pressure measurements, estimated glomerular filtration rate, albuminuria, echocardiographic parameters, and safety of RSD.ResultsNo patient developed procedural or other complications. The ambulatory blood pressure measurements did not differ within the PVI + RSD group or between the PVI + RSD and PVI groups throughout the study. Significantly more patients in the PVI + RSD group than in the PVI group were free of AF at the 12-month follow-up evaluation. The PVI group had an unacceptable response to ablation with respect to changes in echocardiographic parameters, whereas these parameters improved in the PVI + RSD group.ConclusionPVI + RSD were associated with a lower AF recurrence rate than PVI alone; it also improved renal function and some echocardiographic parameters. These encouraging data will serve as baseline information for further long-term studies on larger patient populations.

Renal sympathetic denervation improves clinical outcomes in patients undergoing catheter ablation for atrial fibrillation and history of hypertension: A meta‐analysis

“…PRISMA flow chart for study extraction is presented in Figure . Six studies met the inclusion criteria of which, four were randomized and two were prospective nonrandomized studies . Among 432 patients, 186 underwent RSDN + PVI and 246 underwent PVI.…”

“…Six studies met the inclusion criteria of which, four were randomized [8][9][10][11] and two were prospective nonrandomized studies. 12,13 Among 432 patients, 186 underwent RSDN + PVI and 246 underwent PVI. Baseline characteristics of included studies are presented in Table 1.…”

Effect of combined renal denervation and pulmonary vein isolation in atrial fibrillation recurrence in hypertensive patients: A meta‐analysis

“…Pokushalov showed a significant reduction in the systolic and diastolic blood pressures in the RSDN group from baseline blood pressure measurements at 12 months follow up 18,19 . In contrast, the Kiuchi studies did not report significant blood pressure differences in‐group on follow‐up and compared to baseline for both arms 22,23 . Of note, patients enrolled in those two studies had medication‐controlled baseline blood pressure measurements.…”

“…18,19 In contrast, the Kiuchi studies did not report significant blood pressure differences in-group on follow-up and compared to baseline for both arms. 22,23 Of note, patients enrolled in those two studies had medication-controlled baseline blood pressure measurements. Due to a variation in reporting of the blood pressure outcomes among included studies, we were not able to pool the results together.…”

“…In this meta-analysis, seven eligible studies, composed of five randomized 14,[18][19][20][21] and two prospective nonrandomized studies, 22,23 with a total of 734 patients were included. (Figure 2A to E).…”