The addition of renal sympathetic denervation to pulmonary vein isolation reduces recurrence of paroxysmal atrial fibrillation in chronic kidney disease patients

Kiuchi, Márcio Galindo; Chen, Shaojie; Silva, Gustavo Ramalho e; Paz, Luis Marcelo Rodrigues; Kiuchi, Tetsuaki; Filho, Ary Getúlio de Paula; Souto, Gladyston Luiz Lima

doi:10.1007/s10840-016-0186-6

Cited by 27 publications

(41 citation statements)

References 31 publications

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“…The LA ∆ distension at each 6 months is slower between the 18 th and the 12 th months for both groups. And finally, the LA growth distension rate per month at the end of follow-up, in comparison to 12 th month, was slower only in the AF recurrence group [21][22][23].…”

Section: Discussionmentioning

confidence: 87%

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

Kiuchi¹,

Chen²,

Paz³

et al. 2017

J Integr Cardiol

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Section: Discussionmentioning

confidence: 87%

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

Kiuchi¹,

Chen²,

Paz³

et al. 2017

J Integr Cardiol

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“…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.…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Search Resultsmentioning

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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The addition of renal sympathetic denervation to pulmonary vein isolation reduces recurrence of paroxysmal atrial fibrillation in chronic kidney disease patients

Abstract: PVI + RSD is a safe treatment that is superior to PVI alone for treatment of paroxysmal AF in CKD patients.

Cited by 27 publications

References 31 publications

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

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

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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