Design: Meta-analysis of 6 randomised controlled trials
Population: 516 patients with atrial fibrillation and hypertension undergoing pulmonary vein isolation
Primary outcome: AF recurrence at 12 and 24 months; blood pressure change
Effect: 12-month recurrence RR 0.58 (0.40–0.82); no difference at 24 months (p=0.93); SBP −13.4 mmHg

Six randomised trials including 516 patients with atrial fibrillation and hypertension compared pulmonary vein isolation plus renal sympathetic denervation with pulmonary vein isolation alone.

At 12 months, recurrence was lower with the combined procedure (RR 0.58, 95% CI 0.40–0.82, I² 28%), and systolic blood pressure was about 13 mmHg lower, diastolic about 4.5 mmHg. By 24 months the difference in recurrence had disappeared (p=0.93).

The blood pressure effect is consistent with renal denervation trials in hypertension, though the pooled figure was heterogeneous. The rhythm effect fading by two years suggests the benefit may not last, or that the trials were too small to see it persist. This is a combined procedure few centres offer, and it is not part of guideline AF care.

Treat hypertension actively in patients undergoing AF ablation; it is a modifiable driver of recurrence.
Renal denervation with ablation is investigational for AF; the one-year benefit did not persist at two years.
Expect about 13 mmHg extra systolic lowering at one year from the combined procedure in these trials.
Ask about trial availability if a patient with resistant hypertension is listed for ablation.

Why it matters

It tests whether treating sympathetic drive improves rhythm control, and so far the effect does not last.

The statistics, in plain English

A risk ratio of 0.58 means recurrence at one year was about 40% lower with the combined procedure. I² of 88% for systolic pressure means the trials varied widely in how much blood pressure fell, so the 13 mmHg average hides a wide spread.