title: Pulmonary vein isolation alone and combined with renal sympathetic denervation in chronic kidney disease patients with refractory atrial fibrillation.
abstract: BACKGROUND
  Atrial fibrillation (AF) commonly occurs in association with chronic kidney disease (CKD), resulting in adverse outcomes. Combining pulmonary vein isolation (PVI) and renal sympathetic denervation (RSD) may reduce the recurrence of AF in patients with CKD and hypertension. We considered that RSD could reduce the recurrence of AF in patients with CKD by modulating sympathetic hyperactivity. Our goal was to compare the impact of PVI + RSD with that of PVI alone in patients with concurrent AF and CKD.
  
  
  METHODS
  This was a single-center, prospective, longitudinal, randomized, double-blind study. Forty-five patients with controlled hypertension, symptomatic paroxysmal AF and/or persistent AF, stage 2 or 3 CKD, and a dual-chamber pacemaker were enrolled from January 2014 to January 2015. We assessed the 30-second recurrence of AF recorded by the pacemaker, 24-hour ambulatory blood pressure measurements, estimated glomerular filtration rate, albuminuria, echocardiographic parameters, and safety of RSD.
  
  
  RESULTS
  No patient developed procedural or other complications. The ambulatory blood pressure measurements did not differ within the PVI + RSD group or between the PVI + RSD and PVI groups throughout the study. Significantly more patients in the PVI + RSD group than in the PVI group were free of AF at the 12-month follow-up evaluation. The PVI group had an unacceptable response to ablation with respect to changes in echocardiographic parameters, whereas these parameters improved in the PVI + RSD group.
  
  
  CONCLUSIONS
  PVI + RSD were associated with a lower AF recurrence rate than PVI alone; it also improved renal function and some echocardiographic parameters. These encouraging data will serve as baseline information for further long-term studies on larger patient populations.
authors.affiliation: Division of Cardiac Surgery and Artificial Cardiac Stimulation, Department of Medicine, Hospital e Clínica São Gonçalo, São Gonçalo, Rio de Janeiro, Brazil; Electrophysiology Division, Department of Cardiology, Hospital e Clínica São Gonçalo, São Gonçalo, Rio de Janeiro, Brazil.
authors.forename: Márcio G
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, São Gonçalo, Rio de Janeiro, Brazil.
authors.forename: Gustavo R
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, São Gonçalo, Rio de Janeiro, Brazil.
authors.forename: Luis M R
authors.initials: LM
authors.lastname: Paz
authors.affiliation: Division of Cardiac Surgery and Artificial Cardiac Stimulation, Department of Medicine, Hospital e Clínica São Gonçalo, São Gonçalo, Rio de Janeiro, 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, São Gonçalo, Rio de Janeiro, Brazil.
authors.forename: Ary G
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, São Gonçalo, Rio de Janeiro, Brazil.
authors.forename: Gladyston L L
authors.initials: GL
authors.lastname: Souto
keywords: Atrial fibrillation; Chronic kidney disease; Hypertension; Pacemaker; Renal sympathetic denervation