Renal Sympathetic Denervation Plus Pulmonary Vein Isolation for Atrial Fibrillation in Patients with Hypertension: A Meta-Analysis of Randomised Controlled Trials.

To assess the efficacy and safety of adding adjuvant renal sympathetic denervation (RSDN) to pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). A search of multiple electronic databases was conducted using a comprehensive strategy to identify randomised controlled trials (RCTs) evaluating the impact of RSDN combined with PVI compared with PVI alone in patients with AF and hypertension. The search results were imported to Covidence for article eligibility screening. Six RCTs were included, involving a total of 516 patients. The rate of AF recurrence [RR: 0.58, 95% CI (0.40; 0.82), p = 0.002, I2 = 28%] was significantly lower with RSDN+PVI compared to PVI alone at 12 months, whereas no significant difference was found at 24 months (p = 0.93). RSDN+PVI significantly reduced systolic blood pressure (SBP) at 12 months (MD: -13.41, 95% CI = -15.59; -11.22, p <0.001, I2 = 88%) and diastolic blood pressure (DBP) at 12 months (MD: -4.54, 95% CI -7.66; -1.42, p = 0.004, I2 = 81%) compared to PVI alone. This meta-analysis demonstrated that SBP and DBP, as well as AF recurrence, were lower at 12 months in the PVI plus adjunctive RSDN therapy group than in the PVI-alone group. Key Words: Renal sympathetic denervation, Pulmonary vein isolation, Atrial fibrillation, Hypertension, Catheter ablation, Antiarrhythmic therapy.