Different Strategies to Treat Paroxysmal AF in Patients with Moderate CKD and Severe OSA: a sub group Analysis

Accentuated sympathetic nerve activity is a strong danger feature for cardiovascular major episodes, such as cerebral and myocardial ischemia/infarction.  Peripheric sympathetic nerve activity is emphasized in the hypertensive state, congestive cardiac failure, OSA, heaviness, diabetes, and chronic kidney disease (CKD) subjects. Leastwise a half of individuals with hypertension present augmented sympathetic nerve activity. Our group believes that RSD can reduce AF recurrence in patients with CKD and OSA by modulation of the sympathetic hyperactivity present in these diseases. The goal of this prospective study was to compare the impact of different treatments including CPAP, PVI, RSD, and some combination of them in controlled hypertensive patients with paroxysmal AF, moderate CKD, and severe OSA. Our data suggest that the patients underwent RSD associated to CPAP treatment or PVI, or both of them presented an improvement in the renal function, a decrease in AHI and a lower chance to present AF recurrence than the ones that did not suffer this intervention. Although encouraging, our data are preliminary and need long-term validation in a large population.