{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:58:58Z","timestamp":1760057938118,"version":"build-2065373602"},"reference-count":24,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T00:00:00Z","timestamp":1741046400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Medical University of Silesia","award":["PCN-1-218\/N\/9\/K"],"award-info":[{"award-number":["PCN-1-218\/N\/9\/K"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Heart failure (HF) is a progressive condition associated with reduced life expectancy and quality of life. Atrial fibrillation (AF), the most common arrhythmia in HF patients, significantly worsens symptoms and outcomes. The coexistence of HF and AF is linked to higher morbidity and mortality rates, with a bidirectional relationship exacerbating both conditions. The recent evidence has suggested that combining pulmonary vein isolation (PVI) with renal denervation (RDN) may offer a promising strategy for reducing AF burden and enhancing patient outcomes. Methods: This prospective interventional clinical trial aimed to assess the safety and effectiveness of a combined RDN and PVI approach compared to PVI alone. Eighteen patients, aged 18 to 80 years, with paroxysmal or persistent AF and HF (left ventricular ejection fraction [LVEF] &lt; 50%) were enrolled. RDN was performed under general anesthesia using the four-electrode Symplicity Spyral catheter and Symplicity G3 radiofrequency generator (Medtronic). Patients were randomized to the RDN+PVI group (n = 7) or the PVI-only group (n = 11). The groups were similar in age (59 \u00b1 8.4 years vs. 62.5 \u00b1 11.08 years, p = NS) and baseline characteristics, including hypertension, obesity, and impaired left ventricular function (LVEF 35.86% vs. 38.54%, RDN+PVI vs. PVI only; p = NS). Results: Over a mean follow-up of 24 months, one patient died, ten were hospitalized, six underwent repeat PVI, and eight achieved AF freedom. Patients in the RDN+PVI group were significantly more likely to remain AF-free (n = 6 vs. 2; p = 0.0063). The need for repeat ablation was higher in the PVI-only group (54.5% vs. 0%), though this did not reach statistical significance. Hospitalization rates and changes in ejection fraction were similar between groups. Importantly, no procedural complications were observed. Conclusions: Combining RDN with PVI is a safe hybrid approach for AF management in HF patients, showing promising efficacy in reducing AF recurrence. Larger randomized studies are needed to confirm these findings and further explore this novel therapeutic strategy.<\/jats:p>","DOI":"10.3390\/jcm14051727","type":"journal-article","created":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T05:41:51Z","timestamp":1741066911000},"page":"1727","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Renal Artery Denervation Combined with Pulmonary Vein Isolation in Patients with Heart Failure and Atrial Fibrillation: Pilot Study: Renal Artery Denervation in Treatment of Atrial Fibrillation and Heart Failure"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1149-7457","authenticated-orcid":false,"given":"Tomasz","family":"Skowerski","sequence":"first","affiliation":[{"name":"Department of Cardiology, School of Health Sciences, Medical University of Silesia, 45\/47 Ziolowa Street, 40-635 Katowice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariusz","family":"Skowerski","sequence":"additional","affiliation":[{"name":"Department of Cardiology, School of Health Sciences, Medical University of Silesia, 45\/47 Ziolowa Street, 40-635 Katowice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0335-961X","authenticated-orcid":false,"given":"Iwona","family":"Wozniak-Skowerska","sequence":"additional","affiliation":[{"name":"1st Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 40-635 Katowice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrzej","family":"Hoffmann","sequence":"additional","affiliation":[{"name":"1st Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 40-635 Katowice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3140-1806","authenticated-orcid":false,"given":"Andrzej","family":"Ku\u0142ach","sequence":"additional","affiliation":[{"name":"Department of Cardiology, School of Health Sciences, Medical University of Silesia, 45\/47 Ziolowa Street, 40-635 Katowice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrzej","family":"Ocha\u0142a","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-635 Katowice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katarzyna","family":"Mizia-Stec","sequence":"additional","affiliation":[{"name":"1st Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 40-635 Katowice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zbigniew","family":"Gasior","sequence":"additional","affiliation":[{"name":"Department of Cardiology, School of Health Sciences, Medical University of Silesia, 45\/47 Ziolowa Street, 40-635 Katowice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Grzegorz","family":"Smolka","sequence":"additional","affiliation":[{"name":"Department of Cardiology, School of Health Sciences, Medical University of Silesia, 45\/47 Ziolowa Street, 40-635 Katowice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e11","DOI":"10.15420\/cfr.2023.05","article-title":"Global Public Health Burden of Heart Failure: An Updated Review","volume":"9","author":"Shahim","year":"2023","journal-title":"Card. Fail. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1001\/jamacardio.2023.0695","article-title":"Quality of Care and Clinical Outcomes for Patients with Heart Failure at Hospitals Caring for a High Proportion of Black Adults: Get with the Guidelines-Heart Failure Registry","volume":"8","author":"Diamond","year":"2023","journal-title":"JAMA Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2129","DOI":"10.1161\/CIRCULATIONAHA.120.050850","article-title":"Health-Related Quality of Life and Mortality in Heart Failure The Global Congestive Heart Failure Study of 23000 Patients from 40 Countries","volume":"143","author":"Johansson","year":"2021","journal-title":"Circulation"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1136\/heartjnl-2020-318081","article-title":"Update on Management of Atrial Fibrillation in Heart Failure: A Focus on Ablation","volume":"108","author":"Mulder","year":"2022","journal-title":"Heart"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3314","DOI":"10.1093\/eurheartj\/ehae176","article-title":"2024 ESC Guidelines for the Management of Atrial Fibrillation Developed in Collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"45","author":"Rienstra","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1016\/j.jacc.2023.05.040","article-title":"Global Comparison of Readmission Rates for Patients with Heart Failure","volume":"82","author":"Foroutan","year":"2023","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2476","DOI":"10.1016\/j.jacc.2017.08.074","article-title":"Heart Failure with Preserved, Borderline, and Reduced Ejection Fraction 5-Year Outcomes","volume":"70","author":"Shah","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"4285","DOI":"10.1093\/eurheartj\/ehy727","article-title":"Atrial Fibrillation in Heart Failure Syndromes: Does It Matter More in Some than in Others?","volume":"39","author":"Siontis","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.ijcard.2015.04.016","article-title":"Renal Denervation for the Treatment of Atrial Fibrillation in Hypertensive Patients or Beyond?","volume":"189","author":"Huang","year":"2015","journal-title":"Int. J. Cardiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/j.ijcard.2017.04.029","article-title":"A Potential and Lionhearted Soldier for Atrial Fibrillation Accompanied with Heart Failure: Renal Denervation","volume":"243","author":"Yi","year":"2017","journal-title":"Int. J. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1038\/s41371-022-00658-0","article-title":"Renal Denervation for Atrial Fibrillation: A Comprehensive Updated Systematic Review and Meta-Analysis","volume":"36","author":"Nawar","year":"2022","journal-title":"J. Hum. Hypertens."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1080\/AC.71.1.3132100","article-title":"Renal Sympathetic Denervation Improves Rate Control in Patients with Symptomatic Persistent Atrial Fibrillation and Hypertension","volume":"71","author":"Qiu","year":"2016","journal-title":"Acta Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2388","DOI":"10.1016\/j.hrthm.2016.08.043","article-title":"Renal Sympathetic Denervation for Treatment of Patients with Atrial Fibrillation: Reappraisal of the Available Evidence","volume":"13","author":"Nammas","year":"2016","journal-title":"Heart Rhythm."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1161\/CIRCEP.114.002453","article-title":"Catheter-Based Renal Denervation Reduces Atrial Nerve Sprouting and Complexity of Atrial Fibrillation in Goats","volume":"8","author":"Linz","year":"2015","journal-title":"Circ. Arrhythmia Electrophysiol."},{"key":"ref_16","first-page":"1165","article-title":"Renal Denervation and Pulmonary Vein Isolation in Patients with Drug Resistant Hypertension and Symptomatic Atrial Fibrillation","volume":"7","author":"Wilson","year":"2014","journal-title":"J. Atr. Fibrillation"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1007\/s11886-021-01558-4","article-title":"Renal Denervation for Patients with Atrial Fibrillation","volume":"23","author":"Younis","year":"2021","journal-title":"Curr. Cardiol. Rep."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1001\/jama.2019.21187","article-title":"Effect of Renal Denervation and Catheter Ablation vs. Catheter Ablation Alone on Atrial Fibrillation Recurrence among Patients with Paroxysmal Atrial Fibrillation and Hypertension: The ERADICATE-AF Randomized Clinical Trial","volume":"323","author":"Steinberg","year":"2020","journal-title":"JAMA-J. Am. Med. Assoc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.ijcard.2017.02.085","article-title":"Renal Denervation Regulates the Atrial Arrhythmogenic Substrates through Reverse Structural Remodeling in Heart Failure Rabbit Model","volume":"235","author":"Yamada","year":"2017","journal-title":"Int. J. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1754","DOI":"10.1111\/jce.16344","article-title":"SGLT2i Effect on Atrial Fibrillation: A Network Meta-Analysis of Randomized Controlled Trials","volume":"35","author":"Mariani","year":"2024","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_21","first-page":"725","article-title":"Treatment Strategies for Resistant Arterial Hypertension","volume":"108","author":"Mahfoud","year":"2011","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1097\/HJH.0000000000002335","article-title":"Catheter-Based Renal Denervation as Adjunct to Pulmonary Vein Isolation for Treatment of Atrial Fibrillation: A Systematic Review and Meta-Analysis","volume":"38","author":"Ukena","year":"2020","journal-title":"J. Hypertens."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Romanov, A., Pokushalov, E., Ponomarev, D., Strelnikov, A., Shabanov, V., Losik, D., Karaskov, A., and Steinberg, J.S. (2017). Pulmonary Vein Isolation with Concomitant Renal Artery Denervation Is Associated with Reduction in Both Arterial Blood Pressure and Atrial Fibrillation Burden: Data from Implantable Cardiac Monitor. Cardiovasc. Ther., 35\u201342.","DOI":"10.1111\/1755-5922.12264"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1161\/CIRCULATIONAHA.118.037654","article-title":"A Three-Arm Randomized Trial of Different Renal Denervation Devices and Techniques in Patients With Resistant Hypertension (RADIOSOUND-HTN)","volume":"139","author":"Fengler","year":"2019","journal-title":"Circulation"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/5\/1727\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:46:53Z","timestamp":1760028413000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/5\/1727"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,4]]},"references-count":24,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["jcm14051727"],"URL":"https:\/\/doi.org\/10.3390\/jcm14051727","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2025,3,4]]}}}