Efficacy and Safety Meta-analysis of Whether Denervation Is Combined With Pulmonary Vein Isolation in the Treatment of Hypertension Combined With Atrial Fibrillation

Abstract OBJECTIVE To evaluate the effectiveness of denervation sympathectomy (RDN) and pulmonary vein isolation (PVI) for the treatment of hypertension combined with atrial fibrillation (AF) and to examine the safety of the combined procedure. METHODS Computerized retrieval of clinical research papers concerning PVI combined with RDN for the treatment of patients with hypertension and AF from the databases of Pubmed, Cochrane Library, EMbase, Web of Science, Chinese Academic Journals (CNKI), and Wanfang documented in the period from January 2010 to April 2023 was conducted. Revman 5.3 software and Stata15.1 were used to make meta-analysis. RESULTS A total of 10 papers including 859 patients were enrolled in this study. Meta-analysis showed that 12 months after treatment the recurrence risk of AF was significantly lower in the RDN combined with PVI group compared with the PVI group (RR: 0.61, 95% confidence interval [CI] 0.51 to 0.73, P < 0.01), but pooled analysis showed no difference in AF recurrence rate at 24 months (RR: 0.96, 95% CI 0.63 to 1.45, P = 0.84). The postoperative AF recurrence rate was significantly reduced in the RDN combined with PVI group in patients with paroxysmal AF and refractory hypertension (RR: 0.64, 95% CI 0.51 to 0.81, P < 0.01; RR: 0.70, 95% CI 0.56 to 0.88, P < 0.01). Pooled analysis of patients showed a significant mean reduction of systolic blood pressure (WMD: −6.20 mm Hg, 95% CI −10.79 to −1.62, P < 0.01), septum, left ventricular end-diastolic internal diameter, and left ventricular mass index compared to PVI alone (WMD: −1.25 mm, 95% CI −1.57 to −0.93, P < 0.01; WMD: −2.37 mm, 95% CI −4.63 to −0.11, P = 0.04; WMD: −14.59 g/m2, 95% CI −18.06 to −11.11, P < 0.01); but not diastolic blood pressure (WMD: −3.19 mm Hg, 95% CI −6.81 to 0.44, P = 0.08). Additionally, the pooled analysis showed that PVI + RDN significantly improved estimated glomerular filtration rate (WMD: 14.79 ml/(min·1.73 m2), 95% CI 12.95 to 16.63), reduced creatinine (WMD: −0.27 mg/dl, 95% CI −0.36 to −0.18, P < 0.01), and urinary albumin/urinary creatinine compared to PVI alone (WMD: −50.26, 95% CI −77.01 to −23.52, P < 0.01). In terms of safety, the complication rate was not statistically significant in both groups (1.46, 95% CI 0.75 to 2.83, P = 0.26). CONCLUSIONS RDN combined with PVI surgery can reduce the recurrence rate of AF at 12 months in hypertensive patients with AF, but could not improve the recurrence rate at 24 months after surgery, and the combined surgery has better efficacy and safety.