A Randomized Comparison of Pulmonary Vein Isolation With Versus Without Concomitant Renal Artery Denervatlon in Patients With Refractory Symptomatic Atrial Fibrillation and Resistant Hypertension

摘要

With the advent of renal artery denervation, numerous publications have been forthcoming. Previously, we petitioned the Journal as well as other publications about the lack of citation of our earlier studies (1-6) using intravascular electrode catheters to ablate autonomic nerves on the outside of blood vessels. We can appreciate the reluctance of the Journal to include these citations at that time based on the difference between the intravascular ablation of nerves in the renal arteries affecting blood pressure (7,8) rather than intravascular ablation of nerves outside of blood vessels affecting heart rate and cardiac arrhythmias (9). However, recent reports have documented the consistent and independent effects of renal sympathetic denervation (RSD) on heart rate reduction (10,11). More conclusive evidence supporting our contention is based on the experimental studies of Zhao et al. (12) and the recent clinical study by Pokushalov et al. (13), which have shown that RSD can be used to reduce the incidence of atrial fibrillation. Although the exact mechanisms are still unclear, it has been suggested that ablation of afferent nerves arising from the renal arteries, or other arteries for that matter, can reduce central sympathetic outflow back to the renal nerves as well as via cardiac nerves to the heart, thereby affecting blood pressure (14) as well as heart rate and cardiac arrhythmias (15). Therefore, we are again requesting the Journal to consider including citations of our previous work in future reports dealing with intravascular RSD for resistant hypertension and other collateral benefits.