TCT-581 Renal Sympathetic Denervation as Adjunctive Upstream Therapy during Atrial Fibrillation Ablation: Pooled Analysis of the HFIB and Ultra-HFIB Studies
Recommended Citation
Reddy V, Whang W, Nair D, Lahiri M, Sharma D, Kobayashi T, Doshi S, Natale A, Moskowitz C, Mansour M, Swarup V, Kamran S, Mughal S. TCT-581 Renal Sympathetic Denervation as Adjunctive Upstream Therapy during Atrial Fibrillation Ablation: Pooled Analysis of the HFIB and Ultra-HFIB Studies. J Am Coll Cardiol 2025; 86(17):B253.
Document Type
Conference Proceeding
Publication Date
10-28-2025
Publication Title
J Am Coll Cardiol
Abstract
Background: During catheter ablation to treat atrial fibrillation (AF), adjunctive renal denervation (RDN) improves AF rhythm control, but these studies included only pts with uncontrolled HTN. The HFIB series of pilot studies addressed whether this antiarrhythmic effect of RDN extends to AF patients with controlled hypertension. Methods: We performed a patient-level pooled analysis of HFIB-1 (n=30) and Ultra-HFIB (n=100): both studies randomized AF pts with HTN history, receiving ≥1 anti-HTN med, to AF ablation alone or AF ablation plus RDN with either an off-the-shelf radiofrequency catheter in HFIB-1 (Celsius Thermocool, JNJ MedTech) or an ultrasound RDN system in Ultra-HFIB (Paradise RDN; Recor Medical). The primary endpoint was freedom from AF recurrence (including atrial flutter/tachycardia) off antiarrhythmic drugs at follow-up (2 yr for HFIB-1, 1yr for Ultra-HFIB). Results: The 130-pt cohort was age 65.3±10, 37% female, 82% paroxysmal AF, baseline BP 139/22 mmHg, with AF ablation in 69 pts and ablation+RDN in 61 pts. RDN reduced AF recurrence (HR 0.61, 95%CI 0.35-1.07, p=0.08; I2=0%). In a mixed-effects model with adjustment for age, sex, and AF type, the pooled HR was similar to the unadjusted analysis (HR 0.66, p=0.16). Pooled change in BP was higher in the RD N group by 1 year. [Formula presented] Conclusion: Adjunctive RDN at the time of AF ablation is associated with reduced arrhythmia recurrence, even among pts with relatively controlled hypertension. A fully powered randomized trial is warranted. Our findings suggest a new avenue for treatment of AF by focusing on the sympathetic / renin-angiotensin-aldosterone axis. Categories: STRUCTURAL: Electrophysiology
Volume
86
Issue
17
First Page
B253
