Renal denervation for atrial fibrillation: a comprehensive updated systematic review and meta-analysis

Abstract

The study aims to compare clinical outcomes following renal denervation (RDN) in hypertensive patients with atrial fibrillation (AF). Three online databases were searched (MEDLINE, EMBASE and PubMed) for literature related to outcomes of RDN on hypertension and AF, between January 1, 2010, and June 1, 2021. Where possible, risk ratios (RR) and mean differences (MD) were combined using a random effects model. Significance was set at p ≤ 0.05. Seven trials were included that assessed the effect of adding RDN to pulmonary vein isolation (PVI) in patients with hypertension and AF. A total of 711 patients (329 undergoing PVI + RDN and 382 undergoing PVI alone), with an age range of 56 ± 6 to 68 ± 9 years, were included. Pooled analysis showed a significant lowering of AF recurrence in the PVI + RDN (31.3%) group compared to the PVI-only (52.9%) group (p < 0.00001). Pooled analysis of patients with resistant hypertension showed a significant mean reduction of systolic blood pressure (SBP) (-9.42 mm Hg, p = 0.05), but not diastolic blood pressure (DBP) (-4.11 mm Hg, p = 0.16) in favor of PVI + RDN. Additionally, the pooled analysis showed that PVI + RDN significantly improved estimated glomerular filtration rate (eGFR) (+10.2 mL/min per 1.73 m², p < 0.001) compared to PVI alone. RDN procedures in these trials have proven to be both safe and efficacious with an overall complication rate of 6.32%. Combined PVI and RDN is beneficial for patients with hypertension and AF. Combined therapy showed improvement in SBP and eGFR, reducing the risk of AF recurrence. RDN may serve as an innovative intervention in the treatment of AF.

Fig. 1. PRISMA chart.

Flow chart outlining the screening process for the included/excluded studies and detailing the results following each screening stage.

Fig. 2. Effects of renal denervation on atrial fibrillation.

Forest plot of the pooled comparison between PVI + RDN and PVI alone in the rate of AF recurrence of all included studies. IV inverse variance, df degrees of freedom.

Fig. 3. Effects of renal denervation on blood pressure.

Forest plot of pooled comparison of office BP between PVI + RDN and PVI (A) SBP (B) SBP sensitivity analysis after HFIB-1 removal (C) DBP (D) DBP sensitivity analysis after HFIB-1 removal. IV inverse variance, df degrees of freedom.

Fig. 4. Effects of renal denervation on eGFR.

Forest plot of A pooled comparison of eGFR between PVI + RDN and PVI and B sensitivity analysis after removal of Kiuchi 2017. IV inverse variance, df degrees of freedom.