Background

In the wake of the controversy surrounding the SYMPLICITY HTN-3 trial and data from subsequent trials, this review aims to perform an updated and more comprehensive review of the impact of renal sympathetic denervation on cardiac arrhythmias.

Methods and results

A systematic search was performed using the Medline, Scopus and Embase databases using the terms “Renal Denervation” AND “Arrhythmias or Atrial or Ventricular”, limited to Human and English language studies within the last 10 years. This search yielded 19 relevant studies (n = 6 randomised controlled trials, n = 13 non-randomised cohort studies) which comprised 783 patients. The studies show RSD is a safe procedure, not associated with increases in complications or mortality post-procedure. Importantly, there is no evidence RSD is associated with a deterioration in renal function, even in patients with chronic kidney disease. RSD with or without adjunctive pulmonary vein isolation (PVI) is associated with improvements in freedom from atrial fibrillation (AF), premature atrial complexes (PACs), ventricular arrhythmias and other echocardiographic parameters. Significant reductions in ambulatory and office blood pressure were also observed in the majority of studies.

Conclusion

This review provides evidence based on original research that ‘second generation’ RSD is safe and is associated with reductions in short-term blood pressure and AF burden. However, the authors cannot draw firm conclusions with regards to less prominent arrhythmia subtypes due to the paucity of evidence available. Large multi-centre RCTs investigating the role of RSD are necessary to comprehensively assess the efficacy of the procedure treating various arrhythmias.

Graphic abstract

中文翻译：

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肾去神经治疗心律失常的系统评价

背景

在围绕 SYMPLICITY HTN-3 试验和后续试验数据的争议之后，本综述旨在对肾交感神经去神经支配对心律失常的影响进行更新和更全面的综述。

方法和结果

使用 Medline、Scopus 和 Embase 数据库使用术语“去肾神经”和“心律失常或心房或心室”进行了系统搜索，仅限于过去 10 年内的人类和英语语言研究。该搜索产生了 19 项相关研究（n  = 6 项随机对照试验，n = 13 项非随机队列研究），包括 783 名患者。研究表明，RSD 是一种安全的手术，与手术后并发症或死亡率的增加无关。重要的是，没有证据表明 RSD 与肾功能恶化有关，即使在慢性肾病患者中也是如此。有或没有辅助肺静脉隔离 (PVI) 的 RSD 与无心房颤动 (AF)、房性早搏 (PAC)、室性心律失常和其他超声心动图参数的改善相关。在大多数研究中也观察到动态和办公室血压显着降低。

结论

这篇综述提供了基于原始研究的证据，即“第二代”RSD 是安全的，并且与短期血压和 AF 负担的降低有关。然而，由于缺乏可用的证据，作者无法就不太突出的心律失常亚型得出确切的结论。研究 RSD 作用的大型多中心 RCT 对于全面评估该程序治疗各种心律失常的疗效是必要的。

图形摘要