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

## TL;DR

Combining catheter ablation with renal denervation or ganglion plexus ablation may reduce atrial fibrillation recurrence and improve blood pressure and kidney function.

## Contribution

This study evaluates the effectiveness of combining catheter ablation with RDN or GPA in preventing AF recurrence using network meta-analysis.

## Key findings

- RDN combined with CA showed the highest freedom from AF episodes at 12 and 24 months.
- RDN combined with CA improved blood pressure and renal function compared to CA alone.
- GPA combined with CA had higher procedural complications but also showed effectiveness in reducing AF recurrence.

## Abstract

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.

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

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.

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.