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Hypertension is most common cardiovascular condition responsible for the development and maintenance of atrial fibrillation (AF). While renal denervation (RDN) has been studied to help controlling drug-resistant hypertension its potential value in improving signs and symptoms of AF is currently unknown. The aim of the present pilot study is to assess whether RDN will decrease AF burden and symptoms in patients with symptomatic AF at one-year follow-up as measured using an implantable cardiac monitor (ICM) and the Atrial Fibrillation Effect on QualiTy-of-life [AFEQT] questionnaire.
Between July 2014 and February 2016 a total of 20 patients with symptomatic paroxysmal or persistent AF (EHRA ≥ II) and primary hypertension with a mean office systolic blood pressure (BP) of >140mmHg were enrolled, after enrollment and 3 months before RDN, an ICM was implanted to monitor AF burden prior to the RDN procedure and during the follow-up period. RDN was performed using a dedicated multi-electrode unipolar denervation catheter with the intention to achieve 8 successful ablations per artery. Patients were subsequently followed-up at 1, 3, 6, and 12 months for AF burden, BP control and quality of life using the AFEQT questionnaire.
A total of 11 females and 9 males were included, mean age was 64 ± 7yr. At baseline, 75% of the patients presented in EHRA class II and 25% in EHRA class III. Most patients were on rhythm control (19/20) and 4 patients had a history of pulmonary vein isolation. Office BP decreased from 153 ± 17/88 ± 10mmHg at baseline to 147 ± 17/80 ± 10mmHg at 6 months, while ambulatory BP changed from 131 ± 16/78 ± 9mmHg at baseline to 121 ± 9/72 ± 6mmHg at 6 months (p<0.01). Mean heart rate on 24h holter monitoring remained unchanged. AF minutes/day (median [IQR]) was 1.26 minutes [0-10.6] at baseline versus 0.67 minutes [0- 31.6] at 6 months (p=0.98), the number of AF episodes remained unchanged. At 6 months 75% of the patients were in EHRA class I (p<0.001) and QOL improved significantly. One-year results will be presented at the meeting.
Preliminary results of this single center pilot study suggest that RDN was able to significantly improve symptoms of AF at 6 months. While AF burden measured using an ILR was lower than expected, a numerical change was found in AF burden following RDN.
ENDOVASCULAR: Hypertension Therapies and Renal Denervation