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ARTICLE CONTRIBUTORS

Journal of the American College of Cardiology

Clinical Articles, Lead Article

Renal denervation benefits in drug-resistant hypertension and AF

Renal artery denervation reduces systolic and diastolic blood pressure in patients with drug-resistant hypertension, and reduces atrial fibrillation (AF) recurrences when combined with pulmonary vein isolation (PVI), according to a study published recently in the Journal of the American College of Cardiology.1

The aim of the study was to assess the impact of renal artery denervation in patients with a history of refractory AF and drug-resistant hypertension who were referred for PVI.

Patients with a history of symptomatic paroxysmal or persistent AF refractory to ≥2 antiarrhythmic drugs and drug-resistant hypertension (systolic blood pressure >160 mmHg despite triple drug therapy) were eligible for enrolment. Consenting patients were randomised to PVI only or PVI with renal artery denervation. All patients were followed ≥1 year to assess maintenance of sinus rhythm and to monitor changes in blood pressure.

Imaging of renal arteries before and after ablation. (A, B) Three-dimensional reconstructions with sites of radiofrequency ablation represented in red; (C, D) magnetic resonance imaging scans performed 6 months after ablation, demonstrating no evidence of renal artery stenosis

Imaging of renal arteries before and after ablation. (A, B) Three-dimensional reconstructions with sites of radiofrequency ablation represented in red; (C, D) magnetic resonance imaging scans performed 6 months after ablation, demonstrating no evidence of renal artery stenosis

27 patients were enrolled, and 14 were randomised to PVI only, and 13 were randomised to PVI with renal artery denervation. At the end of the follow-up, significant reductions in systolic and diastolic blood pressure were observed in patients treated with PVI with renal denervation without significant change in the PVI only group. Nine of the 13 patients (69%) treated with PVI with renal denervation were AF-free at the 12-month post-ablation follow-up examination versus 4 (29%) of the 14 patients in the PVI-only group.

In an accompanying editorial,2 Dr Ralph Verdino (University of Pennsylvania, Philadelphia) said: “Although the study cohort is small and one can certainly question the comprehensiveness of documenting arrhythmia recurrence because continuous ambulatory monitoring was not used in this study, the findings are nevertheless impressive”.

He continued: “This study also allows one to wonder whether improved pharmacologic control of hypertension can decrease AF recurrences after catheter ablation of AF or even instead of performing this procedure. Maybe with better control of hypertension, however we physiologically achieve it, we can indeed improve the success rates of catheter ablation of the atria or decrease the need to ever perform this procedure in many patients”.

References

1. Pokushalov E, Romanov A, Corbucci G, et al. A randomized comparison of pulmonary vein isolation with versus without concomitant renal artery denervation in patients with refractory symptomatic atrial fibrillation and resistant hypertension. JACC 2012. http://dx.doi.org/10.1016/j.jacc.2012.05.036

2. Verdino RJ. Catheter ablation for the treatment of atrial fibrillation: have we been targeting the wrong organ? JACC 2012. http://dx.doi.org/10.1016/j.jacc.2012.05.034

Published on: September 27, 2012

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ENDORSED BY

  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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