Surgery: Current Research

ISSN - 2161-1076


Case Report: Renal Sympathetic Denervation + Pulmonary Vein Reisolation in Patients with Long-stand Persistent Atrial Fibrillation and Resistant Hypertension. Does it Work?

Márcio Galindo Kiuchi *,Gustavo Ramalho da Silva ,Luis Marcelo Rodrigues Paz ,Gladyston Luiz Lima Souto

Introduction: A recent study reported that renal sympathetic denervation (RSD) reduces systolic and diastolic blood pressure (BP) in patients with drug-resistant hypertension and reduces atrial fibrillation (AF) recurrences when combined with pulmonary vein isolation (PVI), in a prospective randomized study that assessed the impact of renal artery denervation in patients with a history of refractory AF and drug-resistant hypertension who were referred for PVI.

Case presentation: In this series of cases of long-standing persistent atrial fibrillation (LSPAF) we report 5 cases refractory to treatment with antiarrhythmic drug that underwent to AF catheter ablation, at least one year. The five patients complained about tachycardic palpitations often, as well as, episodes of dyspnea and pre-syncope, were taking amiodarone 200 mg/day and returned to present LSPAF. Moreover, all of them had resistant hypertension besides to possessing other comorbidities. They had normal renal function, and were using the anti-hypertensive medications for at least 3 months, as well as all of them were using dabigatran 150 mg twice a day. All of them underwent to pulmonary vein re-isolation (PVRI) and RSD. All the patients submitted to RSD showed highly significant reduction in office BP and 24-hour APM, both systolic and diastolic at all times points after the procedure. No changes in the renal function were observed before and after the procedure. Even after prompt successful PVRI + RSD procedures, with the 5 patients recovering sinus rhythm, all of them had recurrence of persistent AF in less than one year. After controlling the BP, even all the individuals being in AF, we observed a reduction in left atrial volume at one year post procedure (P = 0.0008), measured by cardiac magnetic resonance. Due to the maintenance of AF we opted to maintain amiodarone and think a third ablation of this arrhythmia in the future with more aggressive strategies or even opt for the control of heart rate, depending on the symptoms of patients.

Conclusions: We can conclude that RSD was effective in controlling BP and associated to PVRI showed a reduction in volume of the left atrium, but in the control of LSPAF, we did not achieve the success.