Renal sympathetic denervation improves rate control in patients with symptomatic persistent atrial fibrillation and hypertension

Aim The aim of this study was to investigate whether renal sympathetic denervation (RSD) improves ventricular heart rate (HR) control in patients with persistent atrial fibrillation (AF). Methods and results Twenty-one patients (aged 57.5 +/- 10.2 years, 76.2% male) with persistent AF and hypertension underwent RSD and completed 7-days follow-up evaluations, including 24-hour Holter monitoring (Holter), blood pressure (BP), 24-hour ambulatory BP monitoring (ABPM). Patients were grouped into tertiles of average HR at baseline Holter recording for evaluation of RSD effects on atrioventricular (AV) node (group 1: HR >= 90 bpm; group 2:80 bpm <= HR <90 bpm; group 3: HR <80 bpm). Results All patients successfully underwent RSD without any complications. The clinical and procedural characteristics were similar in all groups of patients. No significant changes in BP were observed in the three groups before and after RSD. Compared with baseline, the average HR (Holter) of patients in group 1, 2 and 3 had a reduction of 22.6 +/- 13.2 bpm (83.3 +/- 4.9 vs 106.0 +/- 14.6, P=0.004), 9.7 +/- 7.8 bpm (75.7 +/- 7.6 vs 85.4 +/- 3.7, P=0.017) and 2.3 +/- 2.9 bpm (71.4 +/- 4.0 vs 73.7 +/- 4.7, P=0.089) at 7 days after RSD, respectively. Conclusions RSD could improve ventricular HR control in patients with persistent AF. RSD slowed AV node conduction in baseline HR dependent manner. RSD may become an alternative non-pharmaceutical tool for rate control in patients with persistent AF.