Can Renal Denervation Augment Rhythm Control in Atrial Fibrillation?

Despite its efficacy, pulmonary vein isolation (PVI) is limited by suboptimal long-term outcomes. This meta-analysis evaluates renal denervation (RDN) combined with PVI on eliminating atrial fibrillation (AF) and reducing disease burden. A systematic search of MEDLINE, Embase, and Clinicaltrials.gov identified 8 randomized controlled trials comparing RDN + PVI vs PVI alone in AF. Primary outcomes included AF recurrence, freedom from AF, and antiarrhythmic discontinuation. Data analysis was performed using Comprehensive R Archive Network software to calculate pooled effect sizes. A meta-bin module and the Mantel-Haenszel random-effects model were used to compute the pooled relative risk (RR). There was no statistically significant difference in AF recurrence between the 2 groups (RR, 0.75, 95%; P = 0.1212). Discontinuation of antiarrhythmics (RR, 1.85, 95%; P = 0.0864) and freedom from AF (RR, 1.25, 95%; P = 0.2235) did not show a statistically significant difference. However, there was a significant reduction in arrhythmia burden (standard mean difference, -1.17, 95%; P = 0.0271), major adverse cardiac events (RR, 0.33, 95%; P = 0.0029), and left atrial diameter (standard mean difference, -3.22, 95%; P = 0.0372) in the RDN + PVI group. There were no statistically significant differences in all-cause mortality, change in left ventricular ejection fraction, reinitiation of antiarrhythmics, risk of bleeding, stroke, or access site complications between the 2 cohorts. RDN plus PVI did not show a significant advantage in reducing AF recurrence, achieving freedom from AF, facilitating discontinuation of antiarrhythmics, or lowering all-cause mortality. However, it was associated with a significant reduction in arrhythmia burden, major adverse cardiac events, and left atrial diameter.