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

Atti, Varunsiri; Turagam, Mohit K.; Garg, Jalaj; Lakkireddy, Dhanunjaya

doi:10.1111/jce.13868

Cited by 17 publications

(9 citation statements)

References 22 publications

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“…Feyz et al, in the AFFORD study, demonstrate that RSD might be able to decrease AF burden in hypertensive patients, determining a positive effect on quality of life 75 . Finally, same clinical result was recently observed in a metanalysis of six eligible (four randomized and two prospective nonrandomized) studies showing that this combined approach significantly decreased the risk of AF recurrence when compared with PVs isolation alone 76 . Nevertheless, RSD eliminates sympathetic postganglionic axons that can present rapid reinnervation.…”

Section: Non‐direct Cardiac Neuromodulationmentioning

confidence: 68%

Atrial fibrillation and autonomic nervous system: A translational approach to guide therapeutic goals

Rebecchi

Panattoni

Bressi

et al. 2021

Journal of Arrhythmia

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The autonomic nervous system (ANS) is known to play an important role in the genesis and maintenance of atrial fibrillation (AF). Biomolecular and genetic mechanisms, anatomical knowledges with recent diagnostic techniques acquisitions, both invasive and non‐invasive, have enabled greater therapeutic goals in patients affected by AF related to ANS imbalance. Catheter ablation of ganglionated plexi (GP) in the left and right atrium has been proposed in varied clinical conditions. Moreover interesting results arise from renal sympathetic denervation and vagal nerve stimulation. Despite all this, in the scenario of ANS modulation translational strategies we necessary must consider the treatment or correction of dynamic factors such as obesity, obstructive sleep apnea, lifestyle, food, and stress. Finally, new antiarrhythmic drugs, gene therapy and “ablatogenomic” could be represent exciting future therapeutic perspectives.

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Section: Non‐direct Cardiac Neuromodulationmentioning

confidence: 68%

Atrial fibrillation and autonomic nervous system: A translational approach to guide therapeutic goals

Rebecchi

Panattoni

Bressi

et al. 2021

Journal of Arrhythmia

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“…AFFORD study showed that patients with AF and hypertension undergoing RDN benefited in terms of blood pressure control and AF burden reduction [ 193 ]. A small ( N = 432) meta-analysis by Atti V et al demonstrated that RDN plus PVI is superior to PVI alone in reducing post-ablation arrhythmia recurrence in patients with AF (paroxysmal or persistent) and concomitant hypertension (RR: 0.58; 95% CI: 0.47–0.72; p < 0.00001) [ 194 ].…”

Section: Therapeutic Perspectivesmentioning

confidence: 99%

Molecular Insights in Atrial Fibrillation Pathogenesis and Therapeutics: A Narrative Review

et al. 2021

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The prevalence of atrial fibrillation (AF) is bound to increase globally in the following years, affecting the quality of life of millions of people, increasing mortality and morbidity, and beleaguering health care systems. Increasingly effective therapeutic options against AF are the constantly evolving electroanatomic substrate mapping systems of the left atrium (LA) and ablation catheter technologies. Yet, a prerequisite for better long-term success rates is the understanding of AF pathogenesis and maintenance. LA electrical and anatomical remodeling remains in the epicenter of current research for novel diagnostic and treatment modalities. On a molecular level, electrical remodeling lies on impaired calcium handling, enhanced inwardly rectifying potassium currents, and gap junction perturbations. In addition, a wide array of profibrotic stimuli activates fibroblast to an increased extracellular matrix turnover via various intermediaries. Concomitant dysregulation of the autonomic nervous system and the humoral function of increased epicardial adipose tissue (EAT) are established mediators in the pathophysiology of AF. Local atrial lymphomononuclear cells infiltrate and increased inflammasome activity accelerate and perpetuate arrhythmia substrate. Finally, impaired intracellular protein metabolism, excessive oxidative stress, and mitochondrial dysfunction deplete atrial cardiomyocyte ATP and promote arrhythmogenesis. These overlapping cellular and molecular alterations hinder us from distinguishing the cause from the effect in AF pathogenesis. Yet, a plethora of therapeutic modalities target these molecular perturbations and hold promise in combating the AF burden. Namely, atrial selective ion channel inhibitors, AF gene therapy, anti-fibrotic agents, AF drug repurposing, immunomodulators, and indirect cardiac neuromodulation are discussed here.

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“…However, cardiac sympathetic denervation (CSD) is often associated with adverse events 8 . Catheter‐based renal sympathetic denervation (RSDN) (similar to CSD) has recently emerged as a less invasive modality for modulating the autonomic nervous system—and lately, has been increasingly used for the treatment of resistant hypertension and atrial fibrillation 9 . Furthermore, RSDN has been recently described as a possible management approach in patients with recurrent VA refractory to antiarrhythmic drugs and catheter ablation (CA).…”

Section: Introductionmentioning

confidence: 99%

Renal sympathetic denervation for the treatment of recurrent ventricular arrhythmias—ELECTRAM investigators

Garg

Shah

et al. 2021

Pacing Clinical Electrophis

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Introduction Renal sympathetic denervation (RSDN) is an alternate management approach for refractory ventricular arrhythmias (VAs). We aimed to perform a systematic review of clinical outcomes on the impact of RSDN on refractory VA patients. Methods A systematic search without language restriction, using PubMed, EMBASE, SCOPUS, Google Scholar, and ClinicalTrials.gov from inception to August 18, 2020, was performed for the studies that reported outcomes in patients who underwent RSDN for VA. The outcomes studied were—(1) recurrent VA; and (2) all‐cause mortality. Results Five studies (from 2014 to 2018) with a total of 51 VA patients met study inclusion criteria. The mean age was 61.92 ± 11.76 years, and 78.4% were men. The pooled incidence of short‐term (3 months or less) and long‐term (more than 3 months) VA recurrence was 63.85% (95% CI 16.75 to 99.32) and 10.52% (95% CI 0.14 to 28.75), respectively. When stratified by the number of VA episodes, there was a significant reduction in mean VA episodes (SMD ‐3.79, 95% CI ‐6.59 to ‐0.98, p < .01), ICD shocks (SMD ‐1.71, 95% CI ‐3.0 to ‐0.42, p < .01) and anti‐tachycardia pacing (SMD ‐1.21, 95% CI ‐1.98 to ‐0.44, p < .01) following RSDN denervation. The pooled incidence of all‐cause mortality after RSDN was 10.16% (95% CI 1.08 to 24.12). There were no major vascular complications, one minor vascular complication–small non‐flow limiting renal artery dissection (no intervention needed). Conclusion RSDN appears to be a safe and effective treatment strategy in patients with prior failed antiarrhythmic drugs and catheter ablation for recurrent ventricular arrhythmia and electrical storm.

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

Cited by 17 publications

References 22 publications

Atrial fibrillation and autonomic nervous system: A translational approach to guide therapeutic goals

Atrial fibrillation and autonomic nervous system: A translational approach to guide therapeutic goals

Molecular Insights in Atrial Fibrillation Pathogenesis and Therapeutics: A Narrative Review

Renal sympathetic denervation for the treatment of recurrent ventricular arrhythmias—ELECTRAM investigators

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