title: The addition of renal sympathetic denervation to pulmonary vein isolation reduces recurrence of paroxysmal atrial fibrillation in chronic kidney disease patients.
abstract: BACKGROUND
  Atrial fibrillation (AF) frequently complicates chronic kidney disease (CKD). AF treatment is challenging and requires complete pulmonary vein isolation (PVI). Recently, renal sympathetic denervation (RSD) has been reported to reduce AF recurrence when performed alongside PVI.
  
  
  METHODS
  A prospective therapeutic study of patients with controlled hypertension and paroxysmal AF was undertaken. Renal function was evaluated using estimated glomerular filtration rate. Outcomes for patients with normal renal function who underwent PVI (n = 101) were compared with those for CKD patients who underwent either PVI alone (n = 96) or PVI + RSD (n = 39). The primary endpoint was recurrence of AF recorded by 24-h Holter monitoring.
  
  
  RESULTS
  During the 22.4 ± 12.1 months following intervention, the incidence of AF recurrence was higher in CKD patients treated with PVI alone (61.5 %) than in CKD patients treated with PVI + RSD (38.5 %; HR 1.86, 95 % CI 1.14-3.03, P = 0.0251) or patients without CKD subjected to PVI (35.6 %; hazard ratio (HR) 2.27, 95 % confidence interval (CI) 1.51-3.42, P < 0.0001). In particular, the addition of RSD to PVI significantly reduced AF recurrence in CKD stage 4, but not stage 2 or 3, patients. Ambulatory blood pressure and mean heart rate were not different between groups or time points. No complications of either procedure were observed.
  
  
  CONCLUSIONS
  PVI + RSD is a safe treatment that is superior to PVI alone for treatment of paroxysmal AF in CKD patients.
authors.affiliation: Division of Cardiac Surgery and Artificial Cardiac Stimulation, Department of Medicine, Hospital e Clínica São Gonçalo, Rua Cel. Moreira César, 138-Centro, São Gonçalo, Rio de Janeiro, 24440-400, Brazil. marciokiuchi@gmail.com.|Electrophysiology Division, Department of Cardiology, Hospital e Clínica São Gonçalo, São Gonçalo, RJ, Brazil. marciokiuchi@gmail.com.
authors.forename: Márcio Galindo
authors.initials: MG
authors.lastname: Kiuchi
authors.affiliation: Department of Cardiology, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Shaojie
authors.initials: S
authors.lastname: Chen
authors.affiliation: Division of Cardiac Surgery and Artificial Cardiac Stimulation, Department of Medicine, Hospital e Clínica São Gonçalo, Rua Cel. Moreira César, 138-Centro, São Gonçalo, Rio de Janeiro, 24440-400, Brazil.
authors.forename: Gustavo Ramalho
authors.initials: GR
authors.lastname: E Silva
authors.affiliation: Division of Cardiac Surgery and Artificial Cardiac Stimulation, Department of Medicine, Hospital e Clínica São Gonçalo, Rua Cel. Moreira César, 138-Centro, São Gonçalo, Rio de Janeiro, 24440-400, Brazil.
authors.forename: Luis Marcelo
authors.initials: LM
authors.lastname: Rodrigues Paz
authors.affiliation: Division of Cardiac Surgery and Artificial Cardiac Stimulation, Department of Medicine, Hospital e Clínica São Gonçalo, Rua Cel. Moreira César, 138-Centro, São Gonçalo, Rio de Janeiro, 24440-400, Brazil.
authors.forename: Tetsuaki
authors.initials: T
authors.lastname: Kiuchi
authors.affiliation: Division of Cardiac Surgery and Artificial Cardiac Stimulation, Department of Medicine, Hospital e Clínica São Gonçalo, Rua Cel. Moreira César, 138-Centro, São Gonçalo, Rio de Janeiro, 24440-400, Brazil.
authors.forename: Ary Getulio
authors.initials: AG
authors.lastname: de Paula Filho
authors.affiliation: Division of Cardiac Surgery and Artificial Cardiac Stimulation, Department of Medicine, Hospital e Clínica São Gonçalo, Rua Cel. Moreira César, 138-Centro, São Gonçalo, Rio de Janeiro, 24440-400, Brazil.
authors.forename: Gladyston Luiz
authors.initials: GL
authors.lastname: Lima Souto
mesh_terms: D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000601:surgery*; D001938:Brazil / Q000453:epidemiology; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D003131:Combined Modality Therapy / Q000706:statistics & numerical data; D015897:Comorbidity; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000601:surgery*; D018570:Risk Assessment; D055502:Secondary Prevention / Q000706:statistics & numerical data; D013563:Sympathectomy, Chemical / Q000706:statistics & numerical data*; D016896:Treatment Outcome
keywords: Atrial fibrillation; Autonomic nervous system disease; Chronic renal insufficiency; Hypertension; Pulmonary vein; Sympathectomy