Synergy of pulmonary vein isolation and catheter renal denervation in atrial fibrillation complicated with uncontrolled hypertension: Mapping the renal sympathetic nerve and pulmonary vein (the pulmonary vein isolation plus renal denervation strategy)?
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Synergy of pulmonary vein isolation and catheter renal denervation in atrial fibrillation complicated with uncontrolled hypertension: Mapping the renal sympathetic nerve and pulmonary vein (the pulmonary vein isolation plus renal denervation strategy)? / Chen, Shaojie; Kiuchi, Marcio G; Yin, Yuehui; Liu, Shaowen; Schratter, Alexandra; Acou, Willem-Jan; Meyer, Christian; Pürerfellner, Helmut; Chun, K R Julian; Schmidt, Boris.
in: J CARDIOVASC ELECTR, Jahrgang 30, Nr. 5, 05.2019, S. 658-667.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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T1 - Synergy of pulmonary vein isolation and catheter renal denervation in atrial fibrillation complicated with uncontrolled hypertension: Mapping the renal sympathetic nerve and pulmonary vein (the pulmonary vein isolation plus renal denervation strategy)?
AU - Chen, Shaojie
AU - Kiuchi, Marcio G
AU - Yin, Yuehui
AU - Liu, Shaowen
AU - Schratter, Alexandra
AU - Acou, Willem-Jan
AU - Meyer, Christian
AU - Pürerfellner, Helmut
AU - Chun, K R Julian
AU - Schmidt, Boris
N1 - © 2019 Wiley Periodicals, Inc.
PY - 2019/5
Y1 - 2019/5
N2 - INTRODUCTION: Disturbance of sympathetic and vagal nervous system participates in the pathogenesis of hypertension and atrial fibrillation (AF). Renal denervation (RDN) can modulate autonomic nervous activity and reduce blood pressure (BP) in hypertensive patients. We aimed to evaluate the effect of RDN combined with pulmonary vein isolation (PVI) in patients with AF and hypertension.METHODS: Clinical trials including randomized data comparing PVI plus RDN vs PVI alone were enrolled. Primary outcome was incidence of AF recurrence after procedure.RESULTS: A total of 387 patients, of them 252 were randomized and were enrolled. Mean age was 57 ± 10 years, 71% were male, and mean left ventricular ejection fraction was 57.4% ± 6.9%. Follow-up for randomized data was 12 months. Overall comparison for primary outcome showed that PVI + RDN was associated with significantly lower AF recurrence as compared with PVI alone (35.8% vs 55.4%, P < 0.0001). This advantageous effect was consistently maintained among randomized patients (37.3% vs 61.9%, odds ratio = 0.37, P = 0.0001), and among patients with implanted devices for detection of AF recurrence (38.9% vs 61.6%, P = 0.007). Post-hoc sensitivity and regression analysis demonstrated very good stability of this primary result. Pooled Kaplan-Meier analysis further showed that PVI + RDN was associated with significantly higher freedom from AF recurrence as compared with PVI alone (log-rank test, P = 0.001). Besides, RDN resulted in significant BP reduction without additionally increasing the risk of adverse events.CONCLUSIONS: RDN may provide synergetic effects with PVI to reduce the burden of AF and improve BP control in patients with AF and uncontrolled hypertension.
AB - INTRODUCTION: Disturbance of sympathetic and vagal nervous system participates in the pathogenesis of hypertension and atrial fibrillation (AF). Renal denervation (RDN) can modulate autonomic nervous activity and reduce blood pressure (BP) in hypertensive patients. We aimed to evaluate the effect of RDN combined with pulmonary vein isolation (PVI) in patients with AF and hypertension.METHODS: Clinical trials including randomized data comparing PVI plus RDN vs PVI alone were enrolled. Primary outcome was incidence of AF recurrence after procedure.RESULTS: A total of 387 patients, of them 252 were randomized and were enrolled. Mean age was 57 ± 10 years, 71% were male, and mean left ventricular ejection fraction was 57.4% ± 6.9%. Follow-up for randomized data was 12 months. Overall comparison for primary outcome showed that PVI + RDN was associated with significantly lower AF recurrence as compared with PVI alone (35.8% vs 55.4%, P < 0.0001). This advantageous effect was consistently maintained among randomized patients (37.3% vs 61.9%, odds ratio = 0.37, P = 0.0001), and among patients with implanted devices for detection of AF recurrence (38.9% vs 61.6%, P = 0.007). Post-hoc sensitivity and regression analysis demonstrated very good stability of this primary result. Pooled Kaplan-Meier analysis further showed that PVI + RDN was associated with significantly higher freedom from AF recurrence as compared with PVI alone (log-rank test, P = 0.001). Besides, RDN resulted in significant BP reduction without additionally increasing the risk of adverse events.CONCLUSIONS: RDN may provide synergetic effects with PVI to reduce the burden of AF and improve BP control in patients with AF and uncontrolled hypertension.
KW - Adult
KW - Aged
KW - Atrial Fibrillation/diagnosis
KW - Blood Pressure
KW - Catheter Ablation/adverse effects
KW - Female
KW - Heart Rate
KW - Humans
KW - Hypertension/diagnosis
KW - Incidence
KW - Kidney/blood supply
KW - Male
KW - Middle Aged
KW - Pulmonary Veins/physiopathology
KW - Randomized Controlled Trials as Topic
KW - Recurrence
KW - Renal Artery/innervation
KW - Risk Factors
KW - Sympathectomy/adverse effects
KW - Time Factors
KW - Treatment Outcome
U2 - 10.1111/jce.13858
DO - 10.1111/jce.13858
M3 - SCORING: Journal article
C2 - 30680830
VL - 30
SP - 658
EP - 667
JO - J CARDIOVASC ELECTR
JF - J CARDIOVASC ELECTR
SN - 1045-3873
IS - 5
ER -
