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Journal of Interventional Cardiac Electrophysiology

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01-04-2021 | Neurotomy | MULTIMEDIA REPORT

Renal sympathetic denervation in addition to pulmonary vein isolation reduces the recurrence rate of atrial fibrillation: an updated meta-analysis of randomized control trials

Authors: Jakrin Kewcharoen, Wasawat Vutthikraivit, Pattara Rattanawong, Narut Prasitlumkum, Nazem W. Akoum, T. Jared Bunch, Leenhapong Navaravong

Published in: Journal of Interventional Cardiac Electrophysiology | Issue 3/2021

Abstract

Background/purpose

Atrial fibrillation (AF) is the most common arrhythmia worldwide. The sympathetic nervous system plays an important role in initiation and maintenance of AF. Recent studies have shown that renal sympathetic denervation (RSD) reduced AF recurrences after conventional pulmonary vein isolation (PVI). Studies that have evaluated the role of RSD as an adjuvant to PVI have included different patient populations, ablation strategies, and follow-up approaches. We performed a meta-analysis to assess the potential incremental impact of RSD to PVI.

Methods

We searched the databases of MEDLINE and EMBASE from inception to January 2020. Included studies were randomized controlled trials (RCTs) that compared the recurrence rates of AF in patients who underwent PVI and RSD versus PVI alone. Data from each study were combined using the random effects model to calculate odds ratios (OR) and 95% confidence intervals (CIs).

Results

Three RCTs consisted of four different studies during 2014–2020 involving 451 AF patients (223 patients underwent PVI alone and 228 patients underwent PVI with RSD) were included in the meta-analysis. Compared with PVI alone, the PVI with RSD group had a significantly lower risk of AF recurrence (pooled OR = 0.63, 95%CI 0.50–0.80, p < 0.001, I² = 0.0%). There was no publication bias observed in funnel plot as well as no small-study effect observed in Egger’s test.

Conclusions

Our systematic review and meta-analysis demonstrated a significant reduction of AF recurrence in select hypertensive patients who underwent RSD in addition to PVI compared with PVI alone. Larger studies are needed to validate the benefits of this approach in other AF populations and across different ablation strategies.

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Title: Renal sympathetic denervation in addition to pulmonary vein isolation reduces the recurrence rate of atrial fibrillation: an updated meta-analysis of randomized control trials
Authors: Jakrin Kewcharoen
Wasawat Vutthikraivit
Pattara Rattanawong
Narut Prasitlumkum
Nazem W. Akoum
T. Jared Bunch
Leenhapong Navaravong
Publication date: 01-04-2021
Publisher: Springer US
Keywords: Neurotomy
Atrial Fibrillation
Hypertension
Hypertension
Published in: Journal of Interventional Cardiac Electrophysiology / Issue 3/2021
Print ISSN: 1383-875X
Electronic ISSN: 1572-8595
DOI: https://doi.org/10.1007/s10840-020-00748-4

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