Pulmonary vein isolation with concomitant renal artery denervation is associated with reduction in both arterial blood pressure and atrial fibrillation burden: Data from implantable cardiac monitor

Romanov, Alexander; Pokushalov, Evgeny; Ponomarev, Dmitry; Стрельников, А. Г.; Шабанов, В. В.; Losik, Denis; Karaskov, Alexander; Steinberg, Jonathan S.

doi:10.1111/1755-5922.12264

Cited by 36 publications

(33 citation statements)

References 31 publications

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“…We included five studies in qualitative synthesis and five in meta‐analysis (Figure 1). There were a total of 568 subjects from five studies 12‐16 (Table 1).…”

Section: Resultsmentioning

confidence: 99%

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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

Pranata

Vania

Raharjo

2020

Journal of Arrhythmia

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Introduction:This systematic review and meta-analysis aimed to assess the latest evidence on the use of renal denervation (RDN) + pulmonary vein isolation (PVI) compared to PVI alone for treating atrial fibrillation (AF) with hypertension. Methods:A systematic literature search from several electronic databases was performed up until January 2020. The primary outcome was AF recurrence defined as AF/atrial flutter (AFL)/atrial tachycardia (AT) ≥30 seconds at 12-month follow-up and the secondary outcome was procedure-related complications.Results: There were 568 subjects from five studies. AF recurrence was 90/280 (32.1%) in the RDN + PVI group and 142/274 (51.8%) in the PVI group. RDN + PVI was associated with a lower incidence of AF recurrence (RR 0.62 [0.51, 076], P < .001; I 2 : 0%). Pooled analysis of HR showed that RDN + PVI was associated with reduced AF recurrence (HR 0.51 [0.38, 0.70], P < .001; I 2 : 0%). Complications were 7/241 (2.9%) in the RDN + PVI group and 8/237 (3.4%) in the PVI group. The rate of complications between the groups was similar (RR 0.87 [0.33, 2.29], P = .77; I 2 : 0%). In the subgroup analysis of paroxysmal AF, RDN + PVI was shown to reduce AF recurrence (RR 0.64 [0.49, 0.82], P < .001; I 2 : 0% and HR 0.56 [0.38, 0.82], P = .003; I 2 : 0%) compared to PVI alone. RDN + PVI has a moderate certainty of evidence in the reducing AF recurrence with an absolute reduction of 197 fewer per 1000 (from 254 fewer to 124 fewer).Conclusion: RDN in addition to PVI, is associated with reduced 12-month AF recurrence and similar procedure-related complications compared to PVI alone. K E Y W O R D S atrial fibrillation, atrial fibrillation recurrence, catheter ablation, pulmonary vein isolation, renal denervation | 387 PRANATA eT Al. | CON CLUS IONRDN in addition to PVI is associated with reduced 12-month AF recurrence and similar procedure-related complications compared to PVI alone.

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“…We included five studies in qualitative synthesis and five in meta‐analysis (Figure 1). There were a total of 568 subjects from five studies 12‐16 (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…This meta‐analysis showed that RDN + PVI was associated with reduced AF recurrence. Romanov et al reported that RDN in addition to PVI was independently associated with less AF recurrence 15 . There seemed to be no statistically significant difference between those receiving high‐frequency stimulation compared to those without 16 …”

Section: Discussionmentioning

confidence: 99%

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

Vania

Raharjo

2020

Journal of Arrhythmia

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“…PRISMA flow chart for study extraction is presented in Figure 1. 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.…”

Section: Search Resultsmentioning

confidence: 99%

“…It was also hypothesized that optimal blood pressure control influences atrial substrate preventing recurrence of AF . Romanov et al showed a positive correlation between BP reduction and decline in the burden of AF. It has been suggested that a 5 to 10 mmHg reduction in mean BP was associated with a nearly 7% decrease in the mean burden of AF.…”

Section: Discussionmentioning

confidence: 99%

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

Atti

Turagam

Garg

et al. 2019

Cardiovasc electrophysiol

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Background Currently, there is limited data regarding the impact of adjunctive renal sympathetic denervation (RSDN) with pulmonary vein isolation (PVI) in hypertensive patients with atrial fibrillation (AF). Methods A comprehensive literature search for studies comparing RSDN + PVI vs PVI alone for AF and history of hypertension until 1 January 2019 was performed. The results were expressed as risk ratio (RR) for the categorical variables and mean difference (MD) for the continuous variables with 95% confidence intervals (CIs). Results A total of six eligible (four randomized and two prospective nonrandomized) studies consisting of 432 patients (306 paroxysmal AF and 126 persistent AF) were included (RSDN + PVI group: 186 patients and PVI group: 246 patients). Follow‐up is more than or equal to 1 year. Compared with PVI, RSDN + PVI significantly decreased the risk of AF recurrence (RR = 0.58, 95% confidence interval [CI] = 0.47‐0.72, P < 0.00001) on follow‐up. Fluoroscopy (MD = +5.53 minutes, 95% CI = 0.76‐10.31, P = 0.02) and procedure time (MD = +34.85 minutes, 95% CI = 23.55‐46.16, P < 0.00001) was significantly longer with the PVI + RSDN group compared with PVI alone. There were no significant differences in complications between both groups. Test of heterogeneity was low for all clinical outcomes (I2 = 0%). Conclusion Our meta‐analysis demonstrates that RSDN as an adjunct to PVI appears to be safe and improves clinical outcomes in both paroxysmal and persistent AF and history of hypertension

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“…Consequently, five comparative clinical trials were included. [11][12][13][14][15] Table 1 shows the characters of study design. Table 2 summarizes the patients' baseline characteristics of the individual studies.…”

Section: Demographic Resultsmentioning

confidence: 99%

Synergy of pulmonary vein isolation and catheter renal denervation in atrial fibrillation complicated with uncontrolled hypertension: Mapping the renal sympathetic nerve and pulmonary vein (the pulmonary vein isolation plus renal denervation strategy)?

Chen

Kiuchi

Yin

et al. 2019

Cardiovasc electrophysiol

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Introduction Disturbance of sympathetic and vagal nervous system participates in the pathogenesis of hypertension and atrial fibrillation (AF). Renal denervation (RDN) can modulate autonomic nervous activity and reduce blood pressure (BP) in hypertensive patients. We aimed to evaluate the effect of RDN combined with pulmonary vein isolation (PVI) in patients with AF and hypertension. Methods Clinical trials including randomized data comparing PVI plus RDN vs PVI alone were enrolled. Primary outcome was incidence of AF recurrence after procedure. Results A total of 387 patients, of them 252 were randomized and were enrolled. Mean age was 57 ± 10 years, 71% were male, and mean left ventricular ejection fraction was 57.4% ± 6.9%. Follow‐up for randomized data was 12 months. Overall comparison for primary outcome showed that PVI + RDN was associated with significantly lower AF recurrence as compared with PVI alone (35.8% vs 55.4%, P < 0.0001). This advantageous effect was consistently maintained among randomized patients (37.3% vs 61.9%, odds ratio = 0.37, P = 0.0001), and among patients with implanted devices for detection of AF recurrence (38.9% vs 61.6%, P = 0.007). Post‐hoc sensitivity and regression analysis demonstrated very good stability of this primary result. Pooled Kaplan‐Meier analysis further showed that PVI + RDN was associated with significantly higher freedom from AF recurrence as compared with PVI alone (log‐rank test, P = 0.001). Besides, RDN resulted in significant BP reduction without additionally increasing the risk of adverse events. Conclusions RDN may provide synergetic effects with PVI to reduce the burden of AF and improve BP control in patients with AF and uncontrolled hypertension.

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Pulmonary vein isolation with concomitant renal artery denervation is associated with reduction in both arterial blood pressure and atrial fibrillation burden: Data from implantable cardiac monitor

Abstract: Renal artery denervation when added to PVI decreases AF recurrences, AF burden, and mean BP. Reduction in mean BP is associated with both AF burden and recurrences. Further large-scale studies are needed to define the mechanistic pathway(s) of the antiarrhythmic effects of RDN.

Cited by 36 publications

References 31 publications

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

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

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

Synergy of pulmonary vein isolation and catheter renal denervation in atrial fibrillation complicated with uncontrolled hypertension: Mapping the renal sympathetic nerve and pulmonary vein (the pulmonary vein isolation plus renal denervation strategy)?

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