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

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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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Acknowledgments

We would like to thank Dr. Kenneth Nugent, MD, for the critical reading.

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Author notes

  1. Jakrin Kewcharoen and Wasawat Vutthikraivit contributed equally to this work.

Authors and Affiliations

  1. University of Hawaii Internal Medicine Residency Program, 1356 Lusitana St, 7th floor, Honolulu, HI, 96813, USA

    Jakrin Kewcharoen & Narut Prasitlumkum

  2. Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA

    Wasawat Vutthikraivit

  3. Department of Cardiology, Mayo Clinic, Scottsdale, AZ, USA

    Pattara Rattanawong

  4. Division of Cardiovascular Medicine, University of Washington School of Medicine, Seattle, WA, USA

    Nazem W. Akoum

  5. Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA

    T. Jared Bunch & Leenhapong Navaravong

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Contributions

Jakrin Kewcharoen: Conception design, data interpretation, statistical analysis, revision of the manuscript, final approval

Wasawat Vutthikraivit: Conception design, data acquisition, data interpretation, drafting of the manuscript, revision of the manuscript, final approval

Pattara Rattanawong: Corresponding, data interpretation, final approval

Narut Prasitlumkum: Data acquisition, data interpretation, drafting of the manuscript, revision of the manuscript, final approval

Chanavuth Kanitsoraphan: Statistical analysis, drafting of the manuscript, final approval

Nazem W Akoum: Drafting and revision of the manuscript, proofreading, final approval

T Jared Bunch: Drafting and revision of the manuscript, proofreading, final approval

Leenhapong Navaravong: Drafting and revision of the manuscript, proofreading, final approval

Corresponding author

Correspondence to Jakrin Kewcharoen.

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Kewcharoen, J., Vutthikraivit, W., Rattanawong, P. et al. Renal sympathetic denervation in addition to pulmonary vein isolation reduces the recurrence rate of atrial fibrillation: an updated meta-analysis of randomized control trials. J Interv Card Electrophysiol 60, 459–467 (2021). https://doi.org/10.1007/s10840-020-00748-4

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  • DOI: https://doi.org/10.1007/s10840-020-00748-4

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