title: Renal denervation: effects on atrial electrophysiology and arrhythmias.
abstract: Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with significant morbidity and mortality. Currently, atrial endocardial catheter ablation, mainly targeting focal discharges in the pulmonary veins, is the most widely used interventional treatment of drug-refractory AF. Despite technical improvements, results are not yet optimal. There is ongoing search for alternative and/or complementary interventional targets. Conditions associated with increased sympathetic activation such as hypertension, heart failure and sleep apnea lead to structural, neural and electrophysiological changes in the atrium thereby contributing to the progression from paroxysmal to persistent AF and increasing recurrence rate of AF after PVI. Until now, interventional modulation of autonomic nervous system was limited by highly invasive techniques. Catheter-based renal denervation (RDN) was introduced as a minimally invasive approach to reduce renal and whole body sympathetic activation with accompanying blood pressure control and left-ventricular morphological and functional changes in resistant hypertension. This review focuses on the potential atrial antiarrhythmic and antiremodeling effects of RDN in AF patients with hypertension, heart failure, and sleep apnea and discusses the possible role of RDN in the treatment of AF.
authors.affiliation: Klinik für Innere Medizin III Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str. 1, Geb. 40, 66421, Homburg/Saar, Germany, dominik.linz@uks.eu.
authors.forename: Dominik
authors.initials: D
authors.lastname: Linz
authors.forename: Arne
authors.initials: A
authors.lastname: van Hunnik
authors.forename: Christian
authors.initials: C
authors.lastname: Ukena
authors.forename: Sebastian
authors.initials: S
authors.lastname: Ewen
authors.forename: Felix
authors.initials: F
authors.lastname: Mahfoud
authors.forename: Stephan H
authors.initials: SH
authors.lastname: Schirmer
authors.forename: Matthias
authors.initials: M
authors.lastname: Lenski
authors.forename: Hans-Ruprecht
authors.initials: HR
authors.lastname: Neuberger
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schotten
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
mesh_terms: D000818:Animals; D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000601:surgery*; D019317:Evidence-Based Medicine; D006333:Heart Failure / Q000503:physiopathology* / Q000517:prevention & control; D006801:Humans; D006973:Hypertension / Q000503:physiopathology* / Q000517:prevention & control; D012077:Renal Artery / Q000294:innervation* / Q000601:surgery; D012891:Sleep Apnea Syndromes / Q000503:physiopathology* / Q000517:prevention & control; D013562:Sympathectomy / Q000379:methods*; D016896:Treatment Outcome