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

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Indian heart journal Pub Date : 2025-09-04 DOI:10.1016/j.ihj.2025.08.004

Sebastian Emmanuel Willyanto, Liliana Dewi, Rizki Hari Mulia, Imke Maria Del Rosario Puling, Nyoman Deva Pramana Giri, Derren David Christian Homenta Rampengan, Ardian Rizal

{"title":"Preventing atrial fibrillation recurrence with combination of catheter ablation and renal denervation or ganglion plexus ablation: A systematic review and network meta-analysis.","authors":"Sebastian Emmanuel Willyanto, Liliana Dewi, Rizki Hari Mulia, Imke Maria Del Rosario Puling, Nyoman Deva Pramana Giri, Derren David Christian Homenta Rampengan, Ardian Rizal","doi":"10.1016/j.ihj.2025.08.004","DOIUrl":null,"url":null,"abstract":"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.","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":" ","pages":""},"PeriodicalIF":1.8000,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Indian heart journal","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1016/j.ihj.2025.08.004","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

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.

查看原文本刊更多论文

导管消融联合肾去神经或神经节丛消融预防房颤复发：一项系统综述和网络荟萃分析。

背景：房颤（AF）影响着全球约2%的人口，预计在未来50年内还会上升。导管消融（CA）是对症房颤耐药的主要治疗方法。尽管广泛使用，但CA的失败率为20%至50%，由于长期复发率高，通常需要重复手术。CA联合肾去神经（RDN）或神经节丛消融（GPA）可有效降低af的复发率。方法：采用Cochrane ROB 2.0工具进行质量评价，使用RStudio进行网络meta分析，使用RevMan 5.4进行比较meta分析。结果：在7个数据库中进行彻底搜索，得到13篇文章进行分析，其中8篇分类为低风险偏倚，5篇分类为中等风险偏倚。网络meta分析发现，与单独CA相比，RDN + CA在12个月和24个月时AF发作的自由度最高（OR 2.28[1.34-3.86]和OR 1.61[0.89-2.89]），其次是GPA + CA （OR 1.88[0.91-3.89]和OR 1.36[0.91-2.03]）。与单独CA相比，RDN + CA也显示较少的手术相关并发症（OR 0.78[0.30-2.02]），而GPA + CA更普遍（OR 3.60[1.72-7.55]）。此外，与对照组相比，RDN + CA显著降低了收缩压（SBP）（MD -5.22[-9.91- -0.53]）、舒张压（DBP）（MD -3.61[-7.98- -0.76]）和肌酐水平（MD -0.25[-0.34- -0.15]），同时增加了肾小球滤过率（eGFR）（MD 7.98[-1.16-17.11]）。结论：CA联合RDN或GPA可显著预防房颤复发。然而，值得注意的是，GPA + CA与较高的手术相关并发症发生率相关，而RDN + CA通过改善血压调节和肾功能显示出额外的优势。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Indian heart journal CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

2.60

自引率

6.70%

发文量

审稿时长

52 days

期刊介绍： Indian Heart Journal (IHJ) is the official peer-reviewed open access journal of Cardiological Society of India and accepts articles for publication from across the globe. The journal aims to promote high quality research and serve as a platform for dissemination of scientific information in cardiology with particular focus on South Asia. The journal aims to publish cutting edge research in the field of clinical as well as non-clinical cardiology - including cardiovascular medicine and surgery. Some of the topics covered are Heart Failure, Coronary Artery Disease, Hypertension, Interventional Cardiology, Cardiac Surgery, Valvular Heart Disease, Pulmonary Hypertension and Infective Endocarditis. IHJ open access invites original research articles, research briefs, perspective, case reports, case vignette, cardiovascular images, cardiovascular graphics, research letters, correspondence, reader forum, and interesting photographs, for publication. IHJ open access also publishes theme-based special issues and abstracts of papers presented at the annual conference of the Cardiological Society of India.