Abstract
AimThe purpose of this pilot study was to assess whether renal sympathetic denervation (RDN) decreases atrial fibrillation (AF) burden in hypertensive patients with symptomatic AF at 6- and 12-month follow-up, as measured using an implantable cardiac monitor (ICM).Methods and resultsA total of 20 patients with symptomatic paroxysmal or persistent AF (EHRA ≥ II) and primary hypertension with a mean office systolic blood pressure (BP) of > 140 mmHg were enrolled. After enrolment, an ICM was implanted 3 months pre-RDN to monitor AF burden. Quality of life (QOL) was assessed using the Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) questionnaire. Mean age was 64 ± 7 years and 55% were females. AF burden in min/day decreased from a median (IQR) of 1.39 (0–11) pre-RDN to 0.67 (0–31.6) at 6 months (p = 0.64) and to 0.94 (0–6.0) at 12 months (pre-RDN vs. 12 months; p = 0.03). QOL improved significantly at both 6 months (+ 11 ± 15 points, p = 0.006) and 12 months (+ 10 ± 19, p = 0.04) as compared to pre-RDN. Office BP decreased significantly at 12-month follow-up (− 20 ± 19/− 7 ± 10 mmHg), p < 0.01) as compared to pre-RDN. Ambulatory BP decreased − 7 ± 16/− 3 ± 9 mmHg (p > 0.05) at 12-month follow-up as compared to pre-RDN.ConclusionThis pilot study suggests that RDN might be able to decrease AF burden in min/day as measured using an ICM, with a positive effect on QOL. Large-scale randomized trials are needed to prove the definite value of RDN in hypertensive patients with atrial fibrillation.
Highlights
AF is the most common arrhythmia worldwide, occurring in 2–3% of the adult population [1]
Most patients were on rhythm control (19/20) and 20% of the patients had a history of pulmonary vein isolation
The authors described a prolongation of ventricular action potential duration (APD) after RDN, which hypothetically could prevent the occurrence of fatal ventricular arrhythmias (VA)
Summary
AF is the most common arrhythmia worldwide, occurring in 2–3% of the adult population [1]. The incidence of AF, along with an inherent risk for thromboembolic events, increases with age and the presence of hypertension [2]. Hypertension is the most common cardiovascular condition responsible for the development and recurrence of AF [3]. Clinical Research in Cardiology (2019) 108:634–642 sympathetic denervation (RDN) has been studied to help control hypertension [12], its potential value in improving signs and symptoms of AF is currently unknown. The aim of the present pilot study was to assess if RDN decreases occurrence and symptoms of AF in patients with symptomatic paroxysmal or persistent AF at 6- and 12-month follow-up
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