Turagam Mohit K, Whang William, Miller Marc A, Neuzil Petr, Aryana Arash, Romanov Alexander, Cuoco Frank A, Mansour Moussa, Lakkireddy Dhanunjaya, Michaud Gregory F, Dukkipati Srinivas R, Cammack Sam, Reddy Vivek Y
Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Homolka Hospital, Prague, Czech Republic.
JACC Clin Electrophysiol. 2021 Jan;7(1):109-123. doi: 10.1016/j.jacep.2020.08.013. Epub 2020 Oct 28.
This study sought to determine the impact of adjunctive renal sympathetic denervation to catheter ablation in patients with atrial fibrillation (AF) and history of hypertension.
There are limited data regarding the impact of upstream adjunctive renal sympathetic denervation (RSDN) to pulmonary vein isolation (PVI) in patients with symptomatic atrial fibrillation (AF) and hypertension.
The data for this study were obtained from 2 prospective randomized pilot studies, the HFIB (Adjunctive Renal Denervation to Modify Hypertension and Sympathetic tone as Upstream Therapy in the Treatment of Atrial Fibrillation)-1 (n = 30) and HFIB (Adjunctive Renal Denervation to Modify Hypertension and Sympathetic tone as Upstream Therapy in the Treatment of Atrial Fibrillation)-2 (n = 50) studies, and we performed a meta-analysis including all published studies comparing RSDN+PVI versus PVI alone up to January 25, 2020, in patients with AF and hypertension.
At 24 months, AF recurrence occurred in 53% and 38% in the PVI and PVI+RSDN groups (p = 0.43) in the HFIB-1 study, respectively, and 27% and 25% in the PVI and PVI+RSDN groups (p = 0.80) in the HFIB-2 study, respectively. When combined in a meta-analysis including 6 studies (n = 725), adjunctive RSDN significantly decreased the risk of AF recurrence (risk ratio [RR]: 0.68; 95% confidence interval [CI]: 0.55 to 0.83; p = 0.0002; I = 0%) when compared with PVI. Six renal artery complications occurred in the HFIB-1 study and none occurred in the HFIB-2 study with RSDN. However, in the meta-analysis, there were no significant differences in overall complications between both groups (RR: 1.43; 95% CI: 0.63 to 3.22; p = 0.40; I = 7%). When compared with baseline, RDSN significantly reduced the systolic blood pressure (-12.1 mm Hg; 95% CI: -20.9 to -3.3 mm Hg; p < 0.007; I = 99%) and diastolic blood pressure (-5.60 mm Hg; 95% CI: -10.05 to -1.10 mm Hg; p = 0.01; I = 98%) on follow-up.
The pilot HFIB-1 and HFIB-2 studies did not demonstrate a benefit with RSDN as an adjunctive upstream therapy during PVI. However, in the meta-analysis, adjunctive RSDN to PVI appears to be safe, and improves clinical outcomes in AF patients with a history of hypertension.
本研究旨在确定肾交感神经去神经术辅助导管消融对心房颤动（AF）合并高血压病史患者的影响。
关于上游肾交感神经去神经术（RSDN）辅助肺静脉隔离（PVI）对有症状心房颤动（AF）合并高血压患者的影响，数据有限。
本研究的数据来自两项前瞻性随机试点研究，即HFIB（肾去神经辅助治疗心房颤动以改善高血压和交感神经张力的上游治疗）-1（n = 30）和HFIB（肾去神经辅助治疗心房颤动以改善高血压和交感神经张力的上游治疗）-2（n = 50）研究，并且我们进行了一项荟萃分析，纳入了截至2020年1月25日所有已发表的比较RSDN + PVI与单纯PVI治疗AF合并高血压患者的研究。
在HFIB - 1研究中，24个月时，PVI组和PVI + RSDN组的AF复发率分别为53%和38%（p = 0.43），在HFIB - 2研究中，PVI组和PVI + RSDN组的AF复发率分别为27%和25%（p = 0.80）。在纳入6项研究（n = 725）的荟萃分析中，与PVI相比，辅助RSDN显著降低了AF复发风险（风险比[RR]：0.68；95%置信区间[CI]：0.55至0.83；p = 0.0002；I² = 0%）。HFIB - 1研究中发生了6例肾动脉并发症，而HFIB - 2研究中RSDN未发生肾动脉并发症。然而，在荟萃分析中，两组总体并发症无显著差异（RR：1.43；95% CI：0.63至3.22；p = 0.40；I² = 7%）。与基线相比，随访时RDSN显著降低了收缩压（-12.1 mmHg；95% CI：-20.9至-3.3 mmHg；p < 0.007；I² = 99%）和舒张压（-5.60 mmHg；95% CI：-10.05至-1.10 mmHg；p = 0.01；I² = 98%）。
试点HFIB - 1和HFIB - 2研究未证明RSDN作为PVI期间的辅助上游治疗有益。然而，在荟萃分析中，PVI联合RSDN似乎是安全的，并且改善了有高血压病史的AF患者的临床结局。
