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CLEAR FILTERS
Renal Denervation as an Adjunct to Pulmonary Vein Isolation in Atrial Fibrillation Ablation: A Systematic Review and Meta-Analysis
Session:
SESSÃO DE POSTERS 41 - ABLAÇÃO DE FIBRILHAÇÃO AURICULAR
Speaker:
Gonçalo Terleira Batista
Congress:
CPC 2025
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.4 Atrial Fibrillation - Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Gonçalo Terleira Batista; Tatiana Pereira Dos Santos; Ana L. Silva; Mariana Rodrigues Simões; Bernardo Resende; Tomás M. Carlos; Luisa Gomes Rocha; Mafalda Griné; Joana Delgado Silva; Lino Gonçalves
Abstract
<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:14pt">Background: </span></strong>The autonomic nervous system (ANS) plays a critical role in the pathophysiology of atrial fibrillation (AF). Neuromodulation of the ANS through renal denervation (RDN) has emerged as a promising adjunctive therapy to pulmonary vein isolation (PVI) for AF ablation.</span></span></span></p> <p style="text-align:start"> </p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:14pt">Objective: </span></strong>To evaluate the potential benefits of combining RDN with PVI for AF ablation.</span></span></span></p> <p style="text-align:start"> </p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:14pt">Methods</span></strong>: A systematic review of randomized controlled trials (RCTs) was conducted using PubMed, Embase, the Cochrane Central Register of Controlled Trials, and grey literature, covering studies published up to October 2024. Included studies compared PVI alone to PVI combined with RDN. The primary efficacy endpoint was defined as AF recurrence, while procedure-related complications were assessed as the primary safety outcome. Study quality was evaluated using the Cochrane Risk of Bias tool, and data analysis was performed with RevMan 2.0.</span></span></span></p> <p style="text-align:start"> </p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:14pt">Results</span></strong>: Following the initial screening, ten RCTs with a total of 903 participants were included in the analysis (433 in the PVI + RDN arm and 470 in the PVI alone arm). The PVI + RDN group demonstrated significantly lower rates of AF recurrence compared to the PVI alone group (36.5% vs. 53.8%; Odds Ratio [OR]: 0.49; 95% Confidence Interval [CI]: 0.35–0.69; p < 0.001; I² = 23%). The addition of RDN did not lead to an increased rate of procedure-related complications (p = 0.86), and no differences were observed in major adverse cardiovascular events (MACE, defined as death, myocardial infarction, or stroke) (p = 0.29). Similarly, there were no significant differences between the groups in the change in glomerular filtration rate (GFR) from pre- to post-procedure (p = 0.14).</span></span></span></p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Furthermore, the addition of RDN led to a reduction in systolic blood pressure (BP), albeit with substantial heterogeneity among studies (Mean Difference: -6.04 mmHg; 95% CI: -10.92 to -1.17; p = 0.02; I² = 74%). However, no significant differences were found in diastolic BP (p = 0.25).</span></span></span></p> <p style="text-align:start"> </p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusions</strong>: Combining RDN with PVI significantly reduces atrial fibrillation recurrence without increasing procedure-related complications, supporting its potential as an adjunctive therapy in AF ablation.</span></span></span></p>
Slides
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