CIRCULAR PULMONARY VEIN ISOLATION IN COMBINATION WITH RENAL ARTERY DENERVATION IN PATIENTS WITH ATRIAL FIBRILLATION AND RESISTANT ARTERIAL HYPERTENSION

To assess the effect of simultaneous renal artery denervation (RAD) and circulatory pulmonary vein isolation (CPVI) on the clinical course of atrial fibrillation (AF) and arterial hypertension (AH), 35 patients were examined (18 patients with CPVI and 17 patients with CPVI+RAD). In all patients, the complete electric CPVI without additional linear applications was performed. In all patients randomized to the CPVI+RAD group, bilateral RAD was performed immediately after the CPVI procedure. 3D reconstruction of aorta and renal arteries was performed using the navigational system and catheter for pulmonary vein isolation. The access was performed through the femoral artery. Mapping and RAD were carried out at the background of sedation with Propofol. Radiofrequency spiral application (8 10 W) was made from the distal part of the renal artery (from its bifurcation) towards its ostium. The duration of each application was 2 minutes. The number of applications did not exceed 6, and they were made more than 5 mm from the previous in longitudinal-rotary direction. The applications were made in both renal arteries. The complete CPVI was successfully achieved in 35 patients (100%). RAD was successfully performed in all 17 subjects of Group II which led to termination of the blood pressure increase in response to the overdrive suppression after ablation. The number of application per renal artery was 4.4±0.8 (4 6 applications, median: 4). The duration of procedure made up 152±29 min for the CPVI Group and 194±39 min for the CPVI+RAD Group (including 32±18 minutes for RAD; p=0.17). The X ray exposure was 22±17 min for the CPVI group and 29±12 min for the CPVI+RAD Group (including 9±2 min for RAD; p=0.22). No case of renal artery stenosis in patients with RAD was revealed during magnetic resonance tomography 6 months after the surgery. In the patients with RAD, the glomerular filtration rate did not significantly change as compared with the pre-operation data and made up 77.0±6.2 ml/min/1.72 m2 and 82±4.7 ml/min/1.72 m2, respectively, (p=0.42). Twelve months after the surgery, 12 patients of 17 in Group II (70.6%) were free of arrhythmia. In the pulmonary vein isolation group, only 6 patients of 18 (33.4%) were free of AF paroxysms (p=0.01). All 17 patients of Group II showed a decrease in the systolic blood pressure of more than 10 mm Hg after the RAD procedure. Thus, the additional RAD had a positive effect on the sinus rhythm maintenance in patients with AF and resistant AH, in whom CPVI was performed. RAD led to a considerable and stable decrease in the systolic and diastolic blood pressure within 12 months following the surgery.

atrial fibrillation, arterial hypertension, circular pulmonary vein isolation, renal artery denervation, antiarrhythmic therapy

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