Effect of Combined Renal Denervation and Pulmonary Vein Isolation on Atrial Fibrillation: A Systematic Meta-Analysis.

BACKGROUND

Atrial fibrillation (AF) is the most common type of heart arrhythmia. Hypertension (HTN) is known as the most common risk factor for AF. The purpose of this study is to compare clinical results of combined renal denervation (RDN) and pulmonary vein isolation (PVI) in AF patients with HTN.

METHODS

A systematic search was conducted on patients with AF and HTN, comparing the differences between RDN and PVI with PVI alone. The risk ratio (RR) of categorical variables and the mean difference of continuous variables with a 95% confidence interval were applied.

RESULTS

This meta-analysis included 10 studies with a total of 875 patients. 420 patients were in the RDN + PVI group (48%) while 455 (52%) were in the PVI group. 694 patients had paroxysmal AF (79.3%) and 181 patients had persistent AF (20.7%). At 12 months follow-up, the treatment of RDN + PVI reduced the overall risk of AF recurrence in HTN patients (RR = 0.64, P < .001, 95% confidence interval [CI]: 0.55-0.75). When pooled, the patients in the RDN + PVI group showed significant mean reductions in systolic blood pressure (BP) (-13.39 mm Hg, P < .001) and diastolic BP (-7.14 mm Hg, P < .001) compared to PVI alone. Meanwhile, PVI + RDN significantly increased the estimated glomerular filtration rate (+8.72 mL/min/1.73 m2, P < .001) compared with PVI alone. There was no significant difference in complications between the 2 groups.

CONCLUSION

Combined therapy of RDN + PVI seems more efficacious and superior to PVI alone in treating AF. Further and larger trials are needed to fully prove these outcomes.