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Pulmonary vein isolation combined with spironolactone or renal sympathetic denervation in patients with chronic kidney disease, uncontrolled hypertension, paroxysmal atrial fibrillation, and a pacemaker

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Abstract

Background

Atrial fibrillation (AF) commonly occurs in chronic kidney disease (CKD), occasioning adverse outcomes. Merging pulmonary vein isolation (PVI) and renal sympathetic denervation (RSD) may decrease the recurrence of AF in subjects with CKD and uncontrolled hypertension. We considered that RSD could reduce the recurrence of AF in patients with CKD by modulating sympathetic hyperactivity. We aimed to evaluate the impact of RSD or spironolactone 50 mg/day associated with PVI in reducing systolic blood pressure (BP), AF recurrence, and AF burden in patients with a history of paroxysmal AF and mild CKD.

Methods

This was a single-center, prospective, longitudinal, randomized, double-blind study. The individuals were randomly divided into two groups (PVI + spironolactone, n = 36, and PVI + RSD, n = 33). All of them were followed for exactly 1 year to assess maintenance of sinus rhythm and to monitor the other variables.

Results

Ambulatory BP measurements were reduced in both groups and at the 12th month also differed between groups. Significantly more patients in the PVI + RSD (61%) than in the PVI + spironolactone group (36%) were AF-free at the 12th month of follow-up, P = 0.0242. Toward the end of the study, the mean AF burden was lower in the PVI + RSD group as compared to PVI + spironolactone group, at the 9th month: ∆ = − 10% (P < 0.0001), and at the 12th month: ∆ = − 12% (P < 0.0001), respectively.

Conclusions

PVI + RSD is safe and appears to be superior to PVI + spironolactone in BP reduction, augmentation of AF event-free rate, reduction of AF burden, and improvement of renal function.

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Abbreviations

ABPM:

ambulatory blood pressure measurements

AF:

atrial fibrillation

ANS:

autonomic nervous system

BP:

blood pressure

CI:

confidence interval

CKD:

chronic kidney disease

eGFR:

estimated glomerular filtration rate

LA:

left atrium

LV:

left ventricular

LVEF:

left ventricular ejection fraction

PVI:

pulmonary vein isolation

PVs:

pulmonary veins

RF:

radiofrequency

RSD:

renal sympathetic denervation

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Acknowledgements

The authors thank all participants of this study and St. Jude Medical by technical support.

Funding

The study was sponsored by health plans in the state of Rio de Janeiro (US$500,000).

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Authors and Affiliations

  1. Department of Artificial Cardiac Stimulation and Electrophysiology, Cardiostim, Rua Dr. Celestino, 122-1103—Centro, Niterói, RJ, 24020-091, Brazil

    Márcio Galindo Kiuchi

  2. Department of Cardiology, Elisabethinen University Teaching Hospital Linz, Linz, Austria

    Márcio Galindo Kiuchi, Shaojie Chen & Helmut Pürerfellner

  3. Department of Cardiology, Shanghai First People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Shaojie Chen

  4. Department of Renal Medicine, St James’s University Hospital, Leeds, UK

    Neil Alexander Hoye

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  1. Márcio Galindo Kiuchi
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Contributions

Conception and design of the research: M.G.K., S.C., and H.P.

Procedures: M.G.K.

Acquisition of data: T.K.

Analysis and interpretation of the data: S.C. and M.G.K.

Statistical analysis: M.G.K.

Obtaining funding: M.G.K.

Drafting of the manuscript: M.G.K., S.C., N.H., and H.P.

Critical revision of the manuscript for important intellectual content: M.G.K., S.C., N.H., and H.P.

Supervision: H.P.

Corresponding author

Correspondence to Márcio Galindo Kiuchi.

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Kiuchi, M.G., Chen, S., Hoye, N.A. et al. Pulmonary vein isolation combined with spironolactone or renal sympathetic denervation in patients with chronic kidney disease, uncontrolled hypertension, paroxysmal atrial fibrillation, and a pacemaker. J Interv Card Electrophysiol 51, 51–59 (2018). https://doi.org/10.1007/s10840-017-0302-2

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  • DOI: https://doi.org/10.1007/s10840-017-0302-2

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