ИСТИНА

Background: We proposed combining renal sympathetic denervation and catheter ablation of left atrium may improve clinical course in patient with resistant arterial hypertension and atrial fibrillation (AF) Case report: A 62-year-old male patient (BMI: 26.4 kg/m2) was admitted with poorly controlled long-standing hypertension that was resistant to pharmacological therapy with five different anti-hypertensive drugs, namely Irbesartan 300 mg/day, Lercanidipinum 40 mg/day, Carvedilolol 50 mg/day, Torasemide 20 mg/day and Moxonidine 0.6 mg/day. His office blood pressure was 180-210/90-120 mmHg. With 10-year diabetes, his creatinine was concentration of 4.3 mg/dl, glomerular filtration rate (GFR) was 16 ml/min/1.73 m2. Echocardiography showed normal left ventricular systolic function and moderate enlargement of LA. Due to the uncontrolled nature of the resistant hypertension, the patient was eligible for percutaneous renal denervation treatment (RDN). RDN was performed with mean temperature 45°C and 10 W radiofrequency nerve ablations lasted up to 2 minute at each point, with 2 points on the left and 2 points on the right. During procedure we revealed dissection of left renal artery with subsequent stent implantation. The patient was discharged at the fourth day with 140/85 mmHg at office. The patient was prescribed with Lercanidipinum 40 mg/day, Carvedilolol 50 mg/day, Torasemide 10 mg/day and Moxonidine 0.6 mg/day. 3 months after his first hospitalization, he was hospitalized again for catheter ablation because of symptomatic persistent AF. GFR was 16 ml/min/1.73 m2. The ablation performed using 3D mapping system (CARTO-3) and included antral isolation of the PVs with additional left atrial linear ablation of the roof, mitral isthmus and substrate modification of the left atrium posterior wall. Ambulatory blood pressure and ECG have been monitored regularly which revealed an average systolic and diastolic blood pressure of 130/70 mmHg and sustained sinus rhythm without antiarrhythmic drugs 12 months later. Conclusion: Treatment of a patient with AF and resistant arterial hypertension and suffering from severe comorbidities, which combines drug therapy and interventional strategies (RND and ablation of AF), resulted in a significant clinical success, and increased quality of life during one year follow-up.