A Randomized Comparison of Pulmonary Vein Isolation With Versus Without Concomitant Renal Artery Denervation in Patients With Refractory Symptomatic Atrial Fibrillation and Resistant Hypertension
The aim of this prospective randomized study was to assess the impact of renal artery denervation in patients with a history of refractory atrial fibrillation (AF) and drug-resistant hypertension who were referred for pulmonary vein isolation (PVI).
Background
Hypertension is the most common cardiovascular condition responsible for the development and maintenance of AF. Treating drug-resistant hypertension with renal denervation has been reported to control blood pressure, but any effect on AF is unknown.
Methods
Patients with a history of symptomatic paroxysmal or persistent AF refractory to ≥2 antiarrhythmic drugs and drug-resistant hypertension (systolic blood pressure >160 mm Hg despite triple drug therapy) were eligible for enrolment. Consenting patients were randomized to PVI only or PVI with renal artery denervation. All patients were followed ≥1 year to assess maintenance of sinus rhythm and to monitor changes in blood pressure.
Results
Twenty-seven patients were enrolled, and 14 were randomized to PVI only, and 13 were randomized to PVI with renal artery denervation. At the end of the follow-up, significant reductions in systolic (from 181 ± 7 to 156 ± 5, p < 0.001) and diastolic blood pressure (from 97 ± 6 to 87 ± 4, p < 0.001) were observed in patients treated with PVI with renal denervation without significant change in the PVI only group. Nine of the 13 patients (69%) treated with PVI with renal denervation were AF-free at the 12-month post-ablation follow-up examination versus 4 (29%) of the 14 patients in the PVI-only group (p = 0.033).
Conclusions
Renal artery denervation reduces systolic and diastolic blood pressure in patients with drug-resistant hypertension and reduces AF recurrences when combined with PVI. (Combined Treatment of Resistant Hypertension and Atrial Fibrillation; NCT01117025)
Key Words
ablation
atrial fibrillation
renal denervation
resistant hypertension
Abbreviations and Acronyms
AF
atrial fibrillation
ECG
electrocardiogram
HFS
high-frequency stimulation
LV
left ventricular
PAF
paroxysmal atrial fibrillation
PersAF
persistent atrial fibrillation
PVI
pulmonary vein isolation
RF
radiofrequency
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Dr. Corbucci is an employee of Medtronic. Dr. Pokushalov has served as a consultant with Medtronic, Biosense Webster, and Boston Scientific. Dr. Steinberg has served as a consultant with St. Jude Medical, Medtronic, Sanofi-Aventis, Janssen, Biosense-Webster, Ambucor, and Cameron Health; and has received research grants from Medtronic and Biosense-Webster. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
