A randomized comparison of pulmonary vein isolation with versus without concomitant renal artery denervation in patients with refractory symptomatic atrial fibrillation and resistant hypertension

J Am Coll Cardiol. 2012 Sep 25;60(13):1163-70. doi: 10.1016/j.jacc.2012.05.036. Epub 2012 Sep 5.


Objectives: The aim of this prospective randomized study was to assess the impact of renal artery denervation in patients with a history of refractory atrial fibrillation (AF) and drug-resistant hypertension who were referred for pulmonary vein isolation (PVI).

Background: Hypertension is the most common cardiovascular condition responsible for the development and maintenance of AF. Treating drug-resistant hypertension with renal denervation has been reported to control blood pressure, but any effect on AF is unknown.

Methods: Patients with a history of symptomatic paroxysmal or persistent AF refractory to ≥2 antiarrhythmic drugs and drug-resistant hypertension (systolic blood pressure >160 mm Hg despite triple drug therapy) were eligible for enrolment. Consenting patients were randomized to PVI only or PVI with renal artery denervation. All patients were followed ≥1 year to assess maintenance of sinus rhythm and to monitor changes in blood pressure.

Results: Twenty-seven patients were enrolled, and 14 were randomized to PVI only, and 13 were randomized to PVI with renal artery denervation. At the end of the follow-up, significant reductions in systolic (from 181 ± 7 to 156 ± 5, p < 0.001) and diastolic blood pressure (from 97 ± 6 to 87 ± 4, p < 0.001) were observed in patients treated with PVI with renal denervation without significant change in the PVI only group. Nine of the 13 patients (69%) treated with PVI with renal denervation were AF-free at the 12-month post-ablation follow-up examination versus 4 (29%) of the 14 patients in the PVI-only group (p = 0.033).

Conclusions: Renal artery denervation reduces systolic and diastolic blood pressure in patients with drug-resistant hypertension and reduces AF recurrences when combined with PVI.

Trial registration: ClinicalTrials.gov NCT01117025.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Atrial Fibrillation / complications
  • Atrial Fibrillation / surgery*
  • Blood Pressure / physiology
  • Catheter Ablation
  • Combined Modality Therapy
  • Denervation*
  • Double-Blind Method
  • Drug Resistance
  • Electrocardiography
  • Female
  • Follow-Up Studies
  • Humans
  • Hypertension / complications
  • Hypertension / physiopathology
  • Hypertension / surgery*
  • Male
  • Middle Aged
  • Prospective Studies
  • Pulmonary Veins / surgery*
  • Recurrence
  • Renal Artery / innervation*
  • Renal Artery / surgery
  • Treatment Outcome

Associated data

  • ClinicalTrials.gov/NCT01117025