Renal denervation restores autonomic imbalance and prevents atrial fibrillation in patients with hypertensive heart disease : a pilot study
Date
2020-03
Authors
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Journal ISSN
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Publisher
Stellenbosch : Stellenbosch University.
Abstract
ENGLISH ABSTRACT: Background: Atrial fibrillation (AF) is associated with increased cardiovascular morbidity and mortality, but it is uncertain
if catheter-based renal denervation (RD) can reduce AF in patients with hypertensive heart disease (HHD).
Methods: Patients who were ≥ 55 years old, in sinus rhythm, taking ≥ 3 anti-hypertensive drugs including a diuretic,
with echocardiogram-confirmed HHD and suspected coronary artery disease, were randomised to undergo
RD or sham procedure. Patients with renal impairment, significant valvular heart disease and untreated
thyroid disease were excluded. The primary endpoint, the first episode of subclinical AF (SAF) lasting ≥ 6
minutes, was detected using an implantable loop recorder which was scanned every six months. Six-month
follow-up (6MFU) office systolic blood pressure (SBP), cardiovascular mortality and restoration of
autonomic imbalance were secondary endpoints.
Results: Eighty patients were randomised: 42 underwent RD and 38 a sham procedure. After an average follow-up
of three years, fewer RD patients experienced SAF: 6 of 42 patients (14.3%) vs 15 of 38 (39.5%) sham
patients (odds ratio (OR), 0.26; 95% CI, 0.1 to 0.71, p = 0.01). Fast AF (ventricular rate ≥ 100 bpm) occurred
in 10 sham patients (26.3%) vs 1 RD patient (2.4%): OR, 14.64; 95% CI, 1.77 to 120.91; p = 0.002). The
incidence of cardiovascular death was higher in the sham than RD group (6 of 38 (15.8%) vs 1 of 42 (2.4%):
OR, 7.69; 95% CI, 0.88 to 67.12; p = 0.049). Non-ST elevation myocardial infarction (NSTEMI) incidence was
lower in the RD than sham group (2.3% vs 18.4%: OR, 0.108; 95% CI, 0.01–0.92; p = 0.02). The 6MFU
between-group SBP difference was not significant (−3.8 mmHg; p = 0.49). Resting and one-minute recovery
heart rate did not differ between groups at 6MFU.
Conclusion: In patients with HHD, RD reduces subclinical and fast AF, NSTEMI and cardiovascular death independent of
lowering blood pressure. RD was not associated with improvement of surrogate markers of autonomic
imbalance.
Description
Thesis (PhD)--Stellenbosch University, 2020.
Keywords
Atrial fibrillation -- Prevention, Hypertention -- Epidemiology, UCTD, Renal artery -- Surgery, Cardiovascular system -- Diseases