Introduction: Catheter Ablation (CA) has rapidly evolved as an established treatment of Atrial Fibrillation (AF). Nonetheless upstream treatment of atrial fibrillation is highly recommended, and in this respect hypertension (HTN) controlis very important in order to avoid AF relapses. Catheter based renal sympathetic denervation (RSD) using a special designed catheter (not irrigated) has been recently demonstrated efficacy in lowering blood pressure (BP) in drug-refractory hypertensive patients.
Methods: A 59 year male patient with paroxysmal AF referred for CA, that had also a history of drug-resistant HTN (on 4 anti-hypertensive drugs) was elected for both AF ablation and RSD. A cardiac angio CT-scan together with aorta and RA angio CT were undertaken in the day of the procedure. We used Navex System for guiding circumferential isolation of the pulmonary veins (PV). After AF ablation was accomplished we moved for RAD. Via femoral artery access the geometry of the descending aorta and renal arteries were reconstructed with Ensite Velocity and the resulting geometry was combined with the CT scan segmentation model using Ensite fusion, first with add at surface points in the renal arteries ostiaand after a selective angiography of both renal arteries. RF applications of 10 watts, during 30 seconds were delivered through the irrigated catheter separated by >5mm.
Results: After successful PV isolation (common PV ostia in the left, silent right superior PV), 4 RF applications in the left and 5 in the right renal arteries were performed both longitudinally and rotationally. There were no acute complications and the renal arteries angiogram performed after RSD showed no damage. The patient was discharged in the following day. Five days after the procedure the patient BP was 120/80 and amlodipine was suspended.
Conclusions: we report an initial case where simultaneous AF ablation and RSD were safely performed, using the same ablation catheter and navigation system, and to our knowledge this is the first time that RSD was reported, combined with AF ablation, guided by the virtual image created by the fusion of the RA angio CT-scan and the electroanatomical 3-D system Navex .