Preventing atrial fibrillation recurrence with combination of catheter ablation and renal denervation or ganglion plexus ablation: A systematic review and network meta-analysis.

BACKGROUND

Atrial fibrillation (AF), affects around 2 % of the global population and is projected to rise over the next 50 years. Catheter ablation (CA) is the primary treatment for symptomatic AF resistant to drug therapy. Despite its widespread use, CA has a failure rate of 20 %-50 %, often requiring repeat procedures, due to significant long-term recurrence rates. Combining CA with renal denervation (RDN) or ganglion plexus ablation (GPA) may effectively reduce the recurrence rates of AF.

METHODS

Quality assessment was done using the Cochrane ROB 2.0 tool, network meta-analysis using RStudio, and comparative meta-analysis using RevMan 5.4.

RESULTS

A thorough search across seven databases resulted in 13 articles for analysis, with eight classified as low-risk and five as moderate-risk of bias. The network meta-analysis found that RDN + CA had the highest freedom from AF episodes at 12 and 24 months (OR 2.28 [1.34-3.86] and OR 1.61 [0.89-2.89]), followed by GPA + CA (OR 1.88 [0.91-3.89] and OR 1.36 [0.91-2.03]), compared to CA alone. RDN + CA also showed fewer procedure-related complications (OR 0.78 [0.30-2.02]), while GPA + CA was more prevalent (OR 3.60 [1.72-7.55]), compared to CA alone. Additionally, RDN + CA significantly reduced systolic blood pressure (SBP) (MD -5.22 [-9.91 to -0.53]), diastolic blood pressure (DBP) (MD -3.61 [-7.98 to -0.76]), and creatinine levels (MD -0.25 [-0.34 to -0.15]), while increasing estimated glomerular filtration rate (eGFR) (MD 7.98 [-1.16-17.11]) compared to the control group.

CONCLUSION

Remarkable success in preventing AF recurrence was observed when CA was combined with RDN or GPA. However, it is noteworthy that GPA + CA was associated with a higher incidence of procedural-related complications, while RDN + CA demonstrated additional advantages by improving blood pressure regulation and renal function.