The efficacy and safety of renal sympathetic enervation in patients with hypertension and paroxysmal atrial fibrillation

Objectives. The main objective of this study is to investigate whether renal sympathetic denervation (RSD) is effective and safe treatment option in patients with paroxysmalatrial fibrillation (AF). Methods. Subjects (n = 40) with symptomatic paroxysmal AF and hypertension aged18-75 years who had experienced at least one documented relapse of AF during a singletrial of antiarrhythmic drug therapy were enrolled at our center & randomized (1:1) to oneof 2 arms. In group I (active treatment) patients underwent a pulmonary vein isolation (PVI)followed by RSD. In group II (control), we performed only PVI. Follow-up includes physicalexamination, Holter-ECG and ambulatory blood pressure monitoring at baseline and at 1,3, 6 and 12 months after ablation. Symptoms were confirmed by permanent implantableloop recorder. The primary endpoint was freedom from arrhythmia (AF/atrial flutter/atrialtachycardia) >30 sec following a blanking period of 3 months. Results. Primary endpoint was observed in 5/20 (25%) in the group I vs. 4/20 (20%)in the group II (P = NS). Median of time to AF recurrence was 74 days in group I vs. 15 daysin group II (p = NS). RSD decreased the amount of AF episodes lasting more than 1 hour(5% in the group I vs. 30% in the group II; p = 0.04). Conslusions. RSD did not prevent recurrence of AF at the 12-month follow-up, butdecreased the amount of AF episodes lasting more than 1 hour. In RSD there was a trendtowards increased time to AF recurrence during blanking period.