Cardioangiologisches Centrum Bethanien (CCB) Frankfurt am Main, Frankfurt Academy For Arrhythmias (FAFA), Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt, Germany.
School of Medicine-Royal Perth Hospital Unit, University of Western Australia, Perth, Western Australia, Australia.
J Cardiovasc Electrophysiol. 2019 May;30(5):658-667. doi: 10.1111/jce.13858. Epub 2019 Feb 2.
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.
Clinical trials including randomized data comparing PVI plus RDN vs PVI alone were enrolled. Primary outcome was incidence of AF recurrence after procedure.
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.
RDN may provide synergetic effects with PVI to reduce the burden of AF and improve BP control in patients with AF and uncontrolled hypertension.
交感神经和迷走神经系统的紊乱参与了高血压和心房颤动（AF）的发病机制。肾脏去神经支配（RDN）可以调节自主神经活动并降低高血压患者的血压（BP）。我们旨在评估 RDN 联合肺静脉隔离（PVI）在 AF 和高血压患者中的疗效。
纳入了比较 PVI 加 RDN 与单独 PVI 的随机数据临床试验。主要结果是手术后 AF 复发的发生率。
共有 387 名患者，其中 252 名患者被随机分组并纳入研究。平均年龄为 57±10 岁，71%为男性，平均左心室射血分数为 57.4%±6.9%。随机数据的随访时间为 12 个月。总体比较主要结果显示，与单独 PVI 相比，PVI+RDN 与显著较低的 AF 复发率相关（35.8% vs 55.4%，P<0.0001）。在随机分组患者中（37.3% vs 61.9%，优势比=0.37，P=0.0001）和植入用于检测 AF 复发的设备的患者中（38.9% vs 61.6%，P=0.007），这种有利效果一直保持不变。事后敏感性和回归分析表明，该主要结果非常稳定。合并 Kaplan-Meier 分析进一步表明，与单独 PVI 相比，PVI+RDN 与显著更高的 AF 无复发率相关（对数秩检验，P=0.001）。此外，RDN 可显著降低血压，而不会增加不良事件的风险。
RDN 可能与 PVI 协同作用，降低 AF 负担并改善 AF 和未控制高血压患者的血压控制。
