Effect of combined renal denervation and pulmonary vein isolation in atrial fibrillation recurrence in hypertensive patients: A meta-analysis.

BACKGROUND Atrial Fibrillation (AF) is the most common cardiac arrhythmia and hypertension is the most common risk factor associated with AF. The addition of renal sympathetic nerve denervation (RSDN) to pulmonary vein isolation (PVI) in AF patients with hypertension has been reported to improve clinical outcomes. METHODS A systematic search was performed for studies on patients with AF and hypertension that compared RSDN with PVI vs PVI-alone. Risk ratio (RR) for categorical variables and mean difference (MD) for continuous variables with 95% confidence intervals were used. RESULTS 7 studies with a total of 734 patients were included. 340 patients were in the RSDN+PVI group (46.32%) and 394 (53.67%) in the PVI group. 608 patients had paroxysmal AF (83%) while 126 patients had persistent AF (17%). At 12 months follow-up, RSDN+PVI decreased the overall risk of AF recurrence in hypertensive patients with RR 0.60 [95% CI 0.50 - 0.72, p<0.00001]. A sub-group analysis performed in patients with drug-resistant hypertension showed a similar reduction in AF recurrence with RR 0.61[95% CI 0.47 - 0.79, p = 0.0002). Procedure duration MD +28.05 mins [95% CI 18.88 - 37.23, p<0.00001] and fluoroscopy duration MD +5.59 mins [95% CI 3.31 - 8.19, p<0.00001] were significantly longer with the RSDN+PVI group. There was no significant difference in complications between the two groups. CONCLUSION The addition of RSDN to PVI in patients with AF and hypertension appears safe and decreases AF recurrence. Similar results were observed in patients with drug-resistant hypertension. Larger trials are needed to confirm these results. This article is protected by copyright. All rights reserved.