Introduction: Hypertension is a risk factor for developing and maintaining atrial fibrillation (AF). Treating hypertension with renal denervation in drug-resistant patients might not only contribute to a decrease in blood pressure, but also to a decrease in AF recurrences in patients with paroxysmal (P) AF or persistent (Pers) AF. The aim of this prospective, single-center, randomized pilot study was the assessment of the impact of renal denervation and pulmonary vein isolation (PVI) in patients with history of AF and drug-restistant hypertension.
Methods: Patients with history of symptomatic PAF and/or PersAF and drug-resistant hypertension were enrolled in this study. Patients were randomized to pulmonary vein isolation (PVI) only or PVI + Renal denervation. All patients were followed-up for 1 year to assess maintenance of sinus rhythm and to monitor changes in blood pressure.
Results: We enrolled 27 patients with symptomatic AF and drug-resistant hypertension: 14 randomized to PVI only and 13 to PVI + renal denervation. At 12 months FU the reductions in systolic and diastolic blood pressure were successfully and significantly maintained (P<0.001) in patients treated with PVI + renal denervation. On the contrary, no significant change in blood pressure was observed in the PVI only group. Nine (69%) of the 13 patients treated with PVI + renal denervation were AF-free at the 12-month post-ablation FU, versus 4 (29%) of the 14 patients in the PVI only group (Log- Rank test, p=0.033).
Conclusions: Renal ablation is effective in reducing systolic and diastolic blood pressure in patients with drug-resistant hypertension and history of atrial fibrillation. The benefit is maintained at 1 year after the procedure and it has an independent and positive impact on atrial fibrillation recurrences.