Márcio Galindo Kiuchi1,2, Shaojie Chen3, Gustavo Ramalho E Silva4, Luis Marcelo Rodrigues Paz4, Tetsuaki Kiuchi4, Ary Getulio de Paula Filho4, Gladyston Luiz Lima Souto4. 1. 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. 2. Electrophysiology Division, Department of Cardiology, Hospital e Clínica São Gonçalo, São Gonçalo, RJ, Brazil. marciokiuchi@gmail.com. 3. Department of Cardiology, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. 4. 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.
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.
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 CKDpatients 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 CKDpatients treated with PVI alone (61.5 %) than in CKDpatients 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 CKDpatients.
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