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Renal denervation boosts effectiveness of AFib catheter ablation

Key clinical point: Adding renal denervation to atrial fibrillation catheter ablation significantly cut the arrhythmia recurrence rate.

Major finding: Freedom from arrhythmia recurrence during 12-month follow-up was 72% with renal denervation and 57% in controls.

Study details: ERADICATE-AF, a multicenter, randomized study with 302 patients.

Disclosures: ERADICATE-AF did not receive commercial funding. Dr. Steinberg has been a consultant to Allergan, AtriCure, Biosense Webster, Corfigo, G Medical, Medtronic, National Cardiac, and Omron, he owns stock in AliveCor, G Medical, and National Cardiac, and he has received research funding from AliveCor, Biosense Webster, and Medtronic.

Citation:

Steinberg JS et al. Heart Rhythm 2019, Abstract S-LCT01-03.

Commentary:

ERADICATE-AF was a well-performed, informative, and provocative study that produced exciting results. I was very impressed that, despite the added complexity of performing an extra procedure, there appeared to be virtually no added risk to patients, with essentially identical complication rates in the two arms of the study. The 15.6% absolute difference in the rate of arrhythmia recurrences means that about six patients need to have renal denervation added to their catheter ablation to prevent one arrhythmia recurrence during 12 months, a pretty remarkable number-needed-to-treat.

The results also notably showed that the arrhythmia recurrence rates in the two arms of the study continued to separate during 12-month follow-up, indicating ongoing benefit, as well as a durable reduction in blood pressure 12 months after renal denervation.

Despite the successful outcome, adding renal denervation is not a panacea. These patients still had a 28% rate of recurrent atrial fibrillation during follow-up, and on average they also remained above their goal blood pressure despite the pressure reduction that renal denervation produced. The 43% arrhythmia recurrence rate among the patients who underwent only pulmonary vein isolation was consistent with prior reports on the efficacy of this treatment.

The findings raise the question of whether this approach would also work in AFib patients who are not hypertensive, and we must be cautious about the longer-term safety and durability of this treatment.

Cara N. Pellegrini, MD , is director of cardiac electrophysiology at the San Francisco VA Medical Center. She had no disclosures. She made these comments as designated discussant for ERADICATE-AF.