Renal Sympathetic Denervation in Patients With Hypertension and Symptomatic Atrial Fibrillation (RSDforAF)

• Change in atrial fibrillation burden and blood pressure [ Time Frame: from Baseline and 12 months ] [ Designated as safety issue: Yes ]
  To study the effect of renal sympathetic denervation on atrial fibrillation burden and blood pressure in patients with hypertension and symptomatic atrial fibrillation
  
  

• Cardiac function and structure，autonomic nerve function，apnea-hypopnea index and pulse wave velocity ，life quality and laboratory examination [ Time Frame: from Baseline and 12 months ] [ Designated as safety issue: Yes ]
  the effect of renal sympathetic denervation on cardiac function and structure by echocardiographic(include left ventricular ejection fraction，left ventricular end diastolic diameter, ventricular septal thickness, left atrium diameter)，and autonomic nerve function(heart-rate-variability by Holter), fasting blood glucose, glycated hemoglobin，urinary protein，apnea-hypopnea index and pulse wave velocity (PWV), life quality on 36-item short-form(SF-36)Health Survey Questionnaire.
  
  

Atrial fibrillation(AF) is the most common arrhythmia, and its frequency increases with age. Hemodynamic impairment and thromboembolic events related to AF result in significant morbidity, mortality, and cost. Management of patients with AF involves 3 objectives—correction of the rhythm disturbance, rate control, and prevention of thromboembolism. Regardless of whether the rate-control or rhythm-control strategy is pursued, attention must also be directed to antithrombotic therapy for prevention of thromboembolism. Pharmacological cardioversion approaches appear simple but are less efficacious. The major risk is related to poor tolerance of side effects，drug—associated toxicity，and proarrhythmic potentia1 of antiarrhythmic drugs. Radiofrequency catheter ablation of AF has developed rapidly in recent years, but the number of AF recurrences during the long-term follow-up was significant. In addition, the complications associated with AF ablation procedures likely to result in prolonged hospitalization, long-term disability or death. Hypertension is the most important risk factor for AF , Hypertension is associated with left ventricular hypertrophy, impaired ventricular filling, left atrial enlargement, and slowing of atrial conduction velocity. These changes in cardiac structure and physiology favor the development and maintenance of AF, and they increase the risk of thromboembolic complications. In patients with AF, aggressive treatment of hypertension may reverse the structural changes in the heart, reduce thromboembolic complications, and retard or prevent the occurrence of AF. Recently, many clinical researches have verified that Catheter-based renal sympathetic denervation can safely be used to substantially reduce blood pressure, reduce left ventricular hypertrophy, improve glucose tolerance and sleep apnea severity. Simultaneously, a marked reduction in muscle and whole-body sympathetic-nerve activity(MSNA) is apparent, with a decrease in renal and whole-body norepinephrine spillover. Left ventricle hypertrophy, left atrial enlargement, high norepinephrine level，glucose tolerance abnormity and obstructive sleep apnea are all recognized as independent risk factors for the development and recurrence of AF. So, we design this randomized parallel control multi center clinical study to demonstrate whether renal sympathetic denervation is safe and effective in patients with hypertension and symptomatic atrial fibrillation.