Renal Denervation (RDN)
RDN has been hypothesized to decrease AF recurrence rate by ablating the renal sympathetic efferent and afferent nerves that interact with the central autonomic nervous system. The ERADICATE-AF trial (Effect of Renal Denervation and Catheter Ablation vs Catheter Ablation Alone on Atrial Fibrillation Recurrence Among Patients with Paroxysmal Atrial Fibrillation and Hypertension) analyzed 302 patients with PAF and showed improved AF freedom with the addition of RDN to PVI (120). Two recent meta-analyses also supported the idea of additional RDN (121,122). However, these studies have been primarily performed on patients with PAF. The SYMPLICITY AF trial (Renal Nerve Denervation in Patients with Hypertension and Paroxysmal and Persistent Atrial Fibrillation; NCT02064764) is a multicenter trial which explores the efficacy and safety of additional RDN over PVI.