Pulmonary Vein Isolation With Concomitant Renal Artery Denervation Is Associated With Reduction In Both Arterial Blood Pressure And Atrial Fibrillation Burden: Data From Implantable Cardiac Monitor

BackgroundRenal artery denervation (RDN) has provided incremental atrial fibrillation (AF) suppression after pulmonary vein isolation (PVI) in patients with AF in the setting of drug-resistant hypertension.ObjectiveTo assess the relationship between changes of mean blood pressure (BP) and AF recurrences/AF burden after PVI combined with RDN.MethodsAll patients from two randomized studies with symptomatic paroxysmal AF and/or persistent AF and resistant hypertension who underwent PVI-only (n=37) or PVI with RDN (n=39), and implantable cardiac monitor (ICM) implantation were eligible for this study. Mixed-effects linear models were used to investigate the effect of RDN on mean BP and mean AF burden and associations between the two during the 12-month follow-up.ResultsConcomitant RDN was associated with a significant reduction in both mean AF burden (2.43 [95% CI: 1.76-3.09] % vs 6.95 [95% CI: 5.44-8.45] %) and mean BP (104 [95% CI: 103-106] mmHg vs 112 [95% CI: 110-113] mmHg). Decrease in mean BP was positively correlated with decline in mean AF burden: reduction of 5-10mmHg was accompanied by a 7.0% decreased mean AF burden, with greater reduction (up to 20mmHg) associated with on average 17.7% lower mean AF burden.ConclusionsRenal artery denervation when added to PVI decreases AF recurrences, AF burden, and mean BP. Reduction in mean BP is associated with both AF burden and recurrences. Further large-scale studies are needed to define the mechanistic pathway(s) of the antiarrhythmic effects of RDN.