Effects of Renal Sympathetic Denervation in Comparison to β-Blocker on Heart Rate Control in Hypertensive Patients with Permanent Atrial Fibrillation

Abstract

Aim: We aim to compare the effects of renal sympathetic denervation (RSD) to β-blocker use in heart rate (HR), blood pressure (BP) and echocardiographic parameters in hypertensive patients with permanent atrial fibrillation (PAF). Methods and results: Twenty hypertensive patients with PAF and elevated HR were submitted to β-blocker use (n=10) or underwent RSD (n=10) and completed 6 months of follow-up. The enrolled patients had 24-hour-Holter monitoring, 24-hour ABPM and echocardiogram at baseline and at 1st and 6th months of follow-up. Our results showed that in 20 controlled hypertensive patients with PAF there was decrease in maximum, average and minimum HR measured by 24-hour-Holter monitoring during the 6 months of follow-up, both for the group using bisoprolol (n=10) and the group that underwent RSD (n=10). However, we could observe that at the 6th month post RSD the decrease in HR was more intense in average HR (Δ=-12 ± 2 bpm, P<0.0001) and maximum HR (Δ=-21 ± 6 bpm, P=0.0050) in this group than β-blocker group. Furthermore, there was no significant change in mean 24-hour ABPM, and there was a reduction in left atrial diameter (Δ=-2.7 ± 1.2 mm, P=0.0391) in RSD group compared to β-blocker group at the 6th month of follow-up. Conclusions: RSD appears to be safe in the treatment of PAF, as well as, improves some cardiac parameters assessed by echocardiogram. Average and maximum HR, besides LAD appear to be modifiable by the RSD in comparison to β-blocker, mainly at 6th month of follow-up.