Thavabalan Karish, Sheikh Majed, Phuah YuZhi, Rajput Sanjay K, Fatima Noor, Sutaria Aman, Bray Jonathan J H, Ahmad Mahmood, Glatzel Hannah, Ahmad Reubeen, Snell Lily, Kumar Niraj S, García-Pérez Carmen-Lucía, Candilio Luciano, Providencia Rui
University College London Medical School, 74 Huntley St, London WC1E 6DE, UK.
Department of Cardiology, Royal Free Hospital, London, UK.
Eur Heart J Open. 2024 Aug 5;4(4):oeae065. doi: 10.1093/ehjopen/oeae065. eCollection 2024 Jul.
Catheter ablation, consisting of pulmonary vein isolation (PVI), is the most effective treatment modality for the management of symptomatic patients with atrial fibrillation (AF). Unfortunately, this procedure has a considerable relapse rate, ranging from 15 to 50% depending on AF type and other patient factors. Hypertension (HTN) is associated with a higher risk of developing AF and can also be managed with a catheter-based procedure-renal denervation (RDN). This meta-analysis aimed to compare the effect of PVI with and without RDN in hypertensive patients with AF.
OVID MEDLINE and Embase were searched on 1 February 2023 and trials that reported the effects of RDN on AF recurrence in hypertensive patients were included. A total of 637 patients across 8 randomised controlled trials were included. The results from the pooled analysis showed that when compared with PVI alone, RDN added to PVI: (1) Lowered AF recurrence [RR 0.67 (0.53, 0.85), = 0.001, = 23%, NNT = 5.9 patients]; (2) Reduced both systolic blood pressure and diastolic blood pressure, with medium effect size, as reflected by standardised mean differences of 0.5 ( = 0.02, = 80%) and 0.43 ( = 0.006, = 60%), respectively; and (3) was not associated with a decrease in estimated glomerular filtration rate (+7.19 mL/min/1.73 m, = 0.15, = 89%).
Adding RDN to PVI in patients with AF and resistant HTN was associated with a reduction of blood pressure levels and AF recurrence. Consideration to RDN should be given as an adjunctive treatment for patients with AF and resistant HTN.
导管消融术，包括肺静脉隔离（PVI），是治疗有症状心房颤动（AF）患者最有效的治疗方式。不幸的是，该手术有相当高的复发率，根据房颤类型和其他患者因素，复发率在15%至50%之间。高血压（HTN）与发生房颤的较高风险相关，也可通过基于导管的手术——肾去神经支配术（RDN）进行治疗。这项荟萃分析旨在比较有或没有RDN的PVI对高血压合并房颤患者的影响。
于2023年2月1日检索了OVID MEDLINE和Embase，并纳入了报告RDN对高血压患者房颤复发影响的试验。总共纳入了8项随机对照试验中的637名患者。汇总分析结果显示，与单独的PVI相比，PVI联合RDN：（1）降低了房颤复发率[风险比0.67（0.53，0.85），P = 0.001，绝对风险降低23%，需治疗人数 = 5.9例患者]；（2）降低了收缩压和舒张压，效应量中等，标准化均数差分别为0.5（P = 0.02，I² = 80%）和0.43（P = 0.006，I² = 60%）；（3）与估计肾小球滤过率的降低无关（+7.19 mL/min/1.73 m²，P = 0.15，I² = 89%）。
在房颤合并顽固性高血压患者中，PVI联合RDN可降低血压水平和房颤复发率。对于房颤合并顽固性高血压患者，应考虑将RDN作为辅助治疗。
