Renal denervation combined with pulmonary vein isolation increases freedom from atrial fibrillation risk in resistant hypertension patients

BACKGROUND: Renal denervation (RDN) according to the latest ESH guidelines can be considered as a treatment option for patients with resistant hypertension. However, excess sympathetic nervous system activity constitutes an underlying pathophysiological mechanism in many disorders other than arterial hypertension. AIMS: This systematic review and meta-analysis investigated the therapeutic effects of RDN beyond arterial hypertension. METHODS: A systematic review and meta-analysis were conducted following PRISMA guidelines. Electronic databases (PubMed, Embase, Cochrane) were searched for studies assessing RDN effects in atrial fibrillation (AF) recurrence, obstructive sleep apnea (OSA), metabolic parameters, heart failure (HF) and diastolic heart function. Inclusion criteria encompassed randomized controlled trials and observational studies with relevant outcome measures. Effect sizes were pooled using a random-effects model. RESULTS: A total of 16 studies comprising 818 patients were included. RDN was associated with a significant increase in freedom from AF when combined with pulmonary vein isolation (RR: 1.30, 95% CI: 1.04 to 1.61, I = 5%), an improvement in OSA severity as measured by the apnea-hypopnea index (MD: -4.80, 95% CI: -12.60 to 3.01, I = 39%), and decreased fasting blood glucose (MD: -10.04, 95% CI: -26.51 to 6.43, I = 0%). Additionally, RDN led to improvements in left ventricular diastolic function in terms of E/e' reduction (MD: -1.51, 95% CI: -2.71 to -0.31, I = 94%) and improved HF-related biomarkers, specifically NT pro-BNP (MD: -438.54, 95% CI: -1658.57 to 781.49, I = 92%) and 6-min walking distance (MD: +64.58, 95% CI: 0.11 to 129.05, I = 53%). CONCLUSION: This meta-analysis suggests that RDN exerts beneficial effects beyond hypertension, particularly in AF burden, OSA severity, metabolic parameters, and cardiac function. These findings support the broader role of RDN in autonomic regulation and cardiovascular health. Further large-scale trials are warranted to confirm these effects and refine patient selection criteria.