Jakrin Kewcharoen1, Wasawat Vutthikraivit2, Pattara Rattanawong3, Narut Prasitlumkum4, Nazem W Akoum5, T Jared Bunch6, Leenhapong Navaravong6. 1. University of Hawaii Internal Medicine Residency Program, 1356 Lusitana St, 7th floor, Honolulu, HI, 96813, USA. jakrin@hawaii.edu. 2. Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA. 3. Department of Cardiology, Mayo Clinic, Scottsdale, AZ, USA. 4. University of Hawaii Internal Medicine Residency Program, 1356 Lusitana St, 7th floor, Honolulu, HI, 96813, USA. 5. Division of Cardiovascular Medicine, University of Washington School of Medicine, Seattle, WA, USA. 6. Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
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.
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 AFpatients (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 hypertensivepatients 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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