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Background <p>Atrial fibrillation (AF) is a&#xa0;complex arrhythmia often worsened by hypertension (HTN). Pharmacological treatments frequently underperform, and the best approach, particularly combining renal denervation (RDN) with cardiac ablation (CA), remains unclear.</p> Objective <p>We conducted an updated meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy of RDN combined with CA versus CA alone in patients with AF and uncontrolled HTN.</p> Methods <p>We performed a&#xa0;systematic review and meta-analysis of RCTs retrieved from PubMed, Embase, and the Cochrane Library up to July 2024. Primary outcomes included AF recurrence, periprocedural complications, blood pressure changes, and estimated glomerular filtration rate (eGFR). Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were computed using a&#xa0;random-effects model.</p> Results <p>Eight RCTs were included, involving 689 patients (37% female). Of these, 355 underwent RDN + CA, and 334 underwent CA alone, with a&#xa0;mean follow-up of at least 12&#xa0;months. The RDN + CA group exhibited a&#xa0;significant reduction in AF recurrence (RR: 0.77; 95% CI: 0.61–0.97). There were no significant differences in periprocedural complications (RR: 1.06; 95% CI: 0.60–1.89), systolic blood pressure (MD: −6.79; 95% CI: −14.71–1.14), diastolic blood pressure (MD: −2.47; 95% CI: −8.13–3.20), or eGFR (MD: 1.14; 95% CI: −11.95–14.23).</p> Conclusion <p>Our findings show that RDN combined with CA significantly reduces AF recurrence compared to CA alone, presenting a&#xa0;promising approach for patients with resistant HTN and AF.</p>

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Renal denervation plus cardiac ablation vs. cardiac ablation alone for patients with atrial fibrillation and uncontrolled arterial hypertension

  • 期刊论文

  • 发表日期：

    2025年4月9日

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  • Ocílio Ribeiro Gonçalves,
  • Altair Pereira de Melo Neto,
  • Maria Antonia Oliveira Machado Pereira,
  • Victor Arthur Ohannesian,
  • Matheus Augusto Nepomuceno Fernandes,
  • Clara Rocha Dantas,
  • Maria Tereza Camarotti,
  • João Victor Araújo de Oliveira,
  • Gustavo José Silva Sanchez,
  • Carlos Eduardo Batista de Lima,
  • Avelar Alves da Silva

摘要

Background

Atrial fibrillation (AF) is a complex arrhythmia often worsened by hypertension (HTN). Pharmacological treatments frequently underperform, and the best approach, particularly combining renal denervation (RDN) with cardiac ablation (CA), remains unclear.

Objective

We conducted an updated meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy of RDN combined with CA versus CA alone in patients with AF and uncontrolled HTN.

Methods

We performed a systematic review and meta-analysis of RCTs retrieved from PubMed, Embase, and the Cochrane Library up to July 2024. Primary outcomes included AF recurrence, periprocedural complications, blood pressure changes, and estimated glomerular filtration rate (eGFR). Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were computed using a random-effects model.

Results

Eight RCTs were included, involving 689 patients (37% female). Of these, 355 underwent RDN + CA, and 334 underwent CA alone, with a mean follow-up of at least 12 months. The RDN + CA group exhibited a significant reduction in AF recurrence (RR: 0.77; 95% CI: 0.61–0.97). There were no significant differences in periprocedural complications (RR: 1.06; 95% CI: 0.60–1.89), systolic blood pressure (MD: −6.79; 95% CI: −14.71–1.14), diastolic blood pressure (MD: −2.47; 95% CI: −8.13–3.20), or eGFR (MD: 1.14; 95% CI: −11.95–14.23).

Conclusion

Our findings show that RDN combined with CA significantly reduces AF recurrence compared to CA alone, presenting a promising approach for patients with resistant HTN and AF.