Kiuchi Márcio Galindo, Chen Shaojie, Hoye Neil Alexander, Pürerfellner Helmut
Department of Artificial Cardiac Stimulation and Electrophysiology, Cardiostim, Rua Dr. Celestino, 122-1103-Centro, Niterói, RJ, 24020-091, Brazil.
Department of Cardiology, Elisabethinen University Teaching Hospital Linz, Linz, Austria.
J Interv Card Electrophysiol. 2018 Jan;51(1):51-59. doi: 10.1007/s10840-017-0302-2. Epub 2017 Dec 20.
Atrial fibrillation (AF) commonly occurs in chronic kidney disease (CKD), occasioning adverse outcomes. Merging pulmonary vein isolation (PVI) and renal sympathetic denervation (RSD) may decrease the recurrence of AF in subjects with CKD and uncontrolled hypertension. We considered that RSD could reduce the recurrence of AF in patients with CKD by modulating sympathetic hyperactivity. We aimed to evaluate the impact of RSD or spironolactone 50 mg/day associated with PVI in reducing systolic blood pressure (BP), AF recurrence, and AF burden in patients with a history of paroxysmal AF and mild CKD.
This was a single-center, prospective, longitudinal, randomized, double-blind study. The individuals were randomly divided into two groups (PVI + spironolactone, n = 36, and PVI + RSD, n = 33). All of them were followed for exactly 1 year to assess maintenance of sinus rhythm and to monitor the other variables.
Ambulatory BP measurements were reduced in both groups and at the 12th month also differed between groups. Significantly more patients in the PVI + RSD (61%) than in the PVI + spironolactone group (36%) were AF-free at the 12th month of follow-up, P = 0.0242. Toward the end of the study, the mean AF burden was lower in the PVI + RSD group as compared to PVI + spironolactone group, at the 9th month: ∆ = - 10% (P < 0.0001), and at the 12th month: ∆ = - 12% (P < 0.0001), respectively.
PVI + RSD is safe and appears to be superior to PVI + spironolactone in BP reduction, augmentation of AF event-free rate, reduction of AF burden, and improvement of renal function.
心房颤动（AF）常见于慢性肾脏病（CKD），会引发不良后果。合并肺静脉隔离（PVI）和肾交感神经消融术（RSD）可能会降低CKD合并未控制高血压患者的房颤复发率。我们认为RSD可通过调节交感神经过度活跃来降低CKD患者房颤的复发率。我们旨在评估RSD或每天50毫克螺内酯联合PVI对有阵发性房颤病史和轻度CKD患者降低收缩压（BP）、房颤复发率及房颤负荷的影响。
这是一项单中心、前瞻性、纵向、随机、双盲研究。将个体随机分为两组（PVI + 螺内酯组，n = 36；PVI + RSD组，n = 33）。对所有患者进行为期1年的随访，以评估窦性心律的维持情况并监测其他变量。
两组的动态血压测量值均降低，且在第12个月时两组之间也存在差异。在随访的第12个月，PVI + RSD组（61%）无房颤的患者明显多于PVI + 螺内酯组（36%），P = 0.0242。在研究结束时，PVI + RSD组的平均房颤负荷低于PVI + 螺内酯组，在第9个月时：差值 = -10%（P < 0.0001），在第12个月时：差值 = -12%（P < 0.0001）。
PVI + RSD安全，在降低血压、提高无房颤事件发生率、降低房颤负荷及改善肾功能方面似乎优于PVI + 螺内酯。
