Renal denervation to improve catheter ablation outcomes in patients with arterial hypertension and atrial fibrillation

Objective. The aim of this study was to assess the impact of RD in conjunction with pulmonary vein isolation (PVI) on patients with atrial fibrillation (AF) and moderate resistant or severe resistant hypertension. Methods, The data for this study were obtained from two different prospective randomized trials and evaluated by means of meta-analysis. Patients with paroxysmal or persistent AF and moderate resistant hypertension (BP >140/90 mm Hg and 160/100 mm Hg; second study; n = 50) were randomized to PVI or PVI with RD groups and followed up during 18 months. Results, Each group had 55 patients. At 18-months, 35 (63.6%) of the 55 PVI with RD group patients were AF-free vs 22 (40%) of the 55 patients in the PVI-only group (p = 0.013; log-rank test). In patients with severe hypertension, 16 (64%) of the 25 PVI with RD group patients vs 6 (24%) of the 25 PVI-only group patients were AF-free (p = 0.004; log-rank test). For moderate hypertension, the differences were less dramatic: 16 (53.3%) of 30 vs 19 (63.3%) of 30 when RD was added (p = 0.43). Superior efficacy of adding RD was most apparent in persistent AF and resistant hypertension (probability risk 0.24 95%, confidence interval 0.08-0.69, p = 0.012). Conclusion. RD improves the outcomes of PVI, especially in patients with persistent AF and resistant hypertension.