Effect of concomitant Renal DeNervation and cardiac ablation on Atrial Fibrillation recurrence - RDN+AF study

Area of Science:

• Cardiology
• Interventional Cardiology
• Hypertension Management

Background:

• Arterial hypertension (aHT) contributes to cardiac sympathetic activity, which may influence cardiac arrhythmias.
• The antiarrhythmic effects of renal denervation (RDN) in patients with drug-resistant aHT undergoing atrial fibrillation (AF) ablation are not well understood.

Purpose of the Study:

• To evaluate the efficacy of concomitant renal denervation (RDN) and catheter ablation for atrial fibrillation (AF) in patients with uncontrolled, multi-drug resistant arterial hypertension (aHT).
• To assess the impact of RDN+AF ablation on rhythm outcomes, blood pressure control, and safety compared to AF ablation alone.

Main Methods:

• A prospective, randomized, two-center trial (RDN+AF study) enrolled patients with paroxysmal or persistent AF and uncontrolled aHT despite ≥3 antihypertensive drugs.
• Patients were randomized 1:2 to either RDN+AF ablation or AF-only ablation.
• The primary endpoint was freedom from AF episodes >2 min at 12 months, assessed by implantable loop recorder or 7-day Holter ECG.

Main Results:

• 61 patients were randomized. At 12 months, RDN+AF showed a trend towards greater BP reduction, but it was not statistically significant.
• No significant differences in rhythm outcomes were observed between groups at 12 or 24 months (12 months: 61% vs 53%, p=0.622; 24 months: 39% vs 47%, p=0.927).
• Periprocedural complications occurred in 15% of patients; no deaths were reported.

Conclusions:

• Concomitant RDN+AF ablation did not demonstrate superior blood pressure control or rhythm outcomes compared to AF-only ablation in patients with resistant aHT and AF.
• The findings suggest that current RDN strategies may not offer additional antiarrhythmic or antihypertensive benefits in this specific patient population.