Pulmonary Vein Isolation Alone and Combined with Renal Sympathetic Denervation in Chronic Kidney Disease Patients with Refractory Atrial Fibrillation

• Published in: Kidney research and clinical practice 2016, 35(4), , pp.237-244
• Main Authors: Kiuchi, Márcio Galindo, MD, MSc, PhD, Chen, Shaojie, MD, PhD, Ramalho e Silva, Gustavo, MD, Rodrigues Paz, Luis Marcelo, MD, Kiuchi, Tetsuaki, MD, Getulio de Paula Filho, Ary, MD, Lima Souto, Gladyston Luiz, MD, PhD
• Format: Article
• Language: English
• Subjects: Atrial fibrillation; Chronic kidney disease; Hypertension; Nephrology; Original; Pacemaker; Renal sympathetic denervation; 내과학
• ISSN: 2211-9132; 2211-9140
• DOI: 10.1016/j.krcp.2016.08.005

Abstract Background Atrial fibrillation (AF) commonly occurs in association with chronic kidney disease (CKD), resulting in adverse outcomes. Combining pulmonary vein isolation (PVI) and renal sympathetic denervation (RSD) may reduce the recurrence of AF in patients with CKD and hypertension. We considered that RSD could reduce the recurrence of AF in patients with CKD by modulating sympathetic hyperactivity. Objectives Our goal was to compare the impact of PVI+RSD with that of PVI alone in patients with concurrent AF and CKD. Methods This was a single-center, prospective, longitudinal, randomized, double-blind study. Forty-five patients with controlled hypertension, symptomatic paroxysmal AF and/or persistent AF, stage 2 or 3 CKD, and a dual-chamber pacemaker were enrolled from January 2014 to January 2015. We assessed the 30-s recurrence of AF recorded by the pacemaker, 24-h ambulatory blood pressure measurements, estimated glomerular filtration rate, albuminuria, echocardiographic parameters, and safety of RSD. Results No patient developed procedural or other complications. The ambulatory blood pressure measurements did not differ within the PVI+RSD group or between the PVI+RSD and PVI groups throughout the study. Significantly more patients in the PVI+RSD than in the PVI group were AF-free at the 12-month follow-up evaluation. The PVI group had an unacceptable response to ablation with respect to changes in echocardiographic parameters, while these parameters improved in the PVI+RSD group. Conclusions PVI+RSD were associated with a lower AF recurrence rate than PVI alone; it also improved renal function and some echocardiographic parameters. These encouraging data will serve as baseline information for further long-term studies on larger patient populations.