title: A randomized comparison of pulmonary vein isolation with versus without concomitant renal artery denervation in patients with refractory symptomatic atrial fibrillation and resistant hypertension.
abstract: OBJECTIVE
  The aim of this prospective randomized study was to assess the impact of renal artery denervation in patients with a history of refractory atrial fibrillation (AF) and drug-resistant hypertension who were referred for pulmonary vein isolation (PVI).
  
  
  BACKGROUND
  Hypertension is the most common cardiovascular condition responsible for the development and maintenance of AF. Treating drug-resistant hypertension with renal denervation has been reported to control blood pressure, but any effect on AF is unknown.
  
  
  METHODS
  Patients with a history of symptomatic paroxysmal or persistent AF refractory to ≥2 antiarrhythmic drugs and drug-resistant hypertension (systolic blood pressure >160 mm Hg despite triple drug therapy) were eligible for enrolment. Consenting patients were randomized to PVI only or PVI with renal artery denervation. All patients were followed ≥1 year to assess maintenance of sinus rhythm and to monitor changes in blood pressure.
  
  
  RESULTS
  Twenty-seven patients were enrolled, and 14 were randomized to PVI only, and 13 were randomized to PVI with renal artery denervation. At the end of the follow-up, significant reductions in systolic (from 181 ± 7 to 156 ± 5, p < 0.001) and diastolic blood pressure (from 97 ± 6 to 87 ± 4, p < 0.001) were observed in patients treated with PVI with renal denervation without significant change in the PVI only group. Nine of the 13 patients (69%) treated with PVI with renal denervation were AF-free at the 12-month post-ablation follow-up examination versus 4 (29%) of the 14 patients in the PVI-only group (p = 0.033).
  
  
  CONCLUSIONS
  Renal artery denervation reduces systolic and diastolic blood pressure in patients with drug-resistant hypertension and reduces AF recurrences when combined with PVI.
authors.affiliation: State Research Institute of Circulation Pathology, Novosibirsk, Russia. E.Pokushalov@gmail.com
authors.forename: Evgeny
authors.initials: E
authors.lastname: Pokushalov
authors.forename: Alexander
authors.initials: A
authors.lastname: Romanov
authors.forename: Giorgio
authors.initials: G
authors.lastname: Corbucci
authors.forename: Sergey
authors.initials: S
authors.lastname: Artyomenko
authors.forename: Vera
authors.initials: V
authors.lastname: Baranova
authors.forename: Alex
authors.initials: A
authors.lastname: Turov
authors.forename: Natalya
authors.initials: N
authors.lastname: Shirokova
authors.forename: Alexander
authors.initials: A
authors.lastname: Karaskov
authors.forename: Suneet
authors.initials: S
authors.lastname: Mittal
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Steinberg
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000601:surgery*; D001794:Blood Pressure / Q000502:physiology; D017115:Catheter Ablation; D003131:Combined Modality Therapy; D003714:Denervation; D004311:Double-Blind Method; D004351:Drug Resistance; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence; D012077:Renal Artery / Q000294:innervation* / Q000601:surgery; D016896:Treatment Outcome