No abstract

Background Enlargement of left atrial ( LA ) size indicates advanced disease stage in patients with atrial fibrillation ( AF ) and is associated with poor success of different AF therapies. Two dimensional echocardiographic LA measurements do not reliably reflect the true size of LA anatomy. The aim of the current study was: 1) to analyze cardiovascular magnetic resonance ( CMR )‐derived LA dimensions and their association with low voltage areas ( LVA ); and 2) to investigate the association between these parameters and NT ‐pro ANP (N‐terminal proatrial natriuretic peptide) levels. Methods and Results Patients undergoing first AF catheter ablation were included. All patients underwent CMR imaging (Ingenia 1.5T Philips) before intervention. CMR data ( LA volume, superior–inferior, transversal and anterior–posterior LA diameters) were measured in all patients. LVA were determined using high‐density maps and a low voltage threshold <0.5 mV. Blood plasma samples from femoral vein were collected before catheter ablation. NT ‐pro ANP levels were studied using commercially available assays. There were 216 patients (65±11 years, 59% males, 56% persistent AF , 26% LVA ) included into analyses. NT ‐pro ANP levels in patients with LVA were significantly higher than in those without (median/interquartile range 22 [13–29] versus 15 [9–22] pg/mL, P =0.004). All CMR derived LA diameters correlated significantly with persistent AF ( r ²=0.291–0.468, all P <0.001), LVA ( r ²=0.187–0.306, all P <0.001), and NT ‐pro ANP levels ( r ²=0.258–0.352, P <0.01). On logistic regression multivariable analysis, age (odds ratio=1.090, 95% confidence interval: 1.030–1.153, P =0.003), females (odds ratio=2.686, 95% confidence interval: 1.047–6.891, P =0.040), and LA volume (odds ratio=1.022, 95% confidence interval: 1.009–1.035, P =0.001) remained significant predictors for LVA . Conclusions ...

Background In patients with atrial fibrillation (AF), left atrial (LA) enlargement, and the presence of low‐voltage areas (LVAs) indicate an advanced disease stage. NT‐proANP is a biomarker, which is significantly higher in both phenotypes. Prediction of LVAs before catheter ablation could impact the prognosis and therapeutical management in AF patients. Objective The aim of this study was to (a) analyze the predictive value of a novel biomarker‐based AF substrate prediction score, and (b) compare it with DR‐FLASH and APPLE scores. Methods Patients undergoing first AF catheter ablation were included. LA volume (LAV) was analyzed prior to ablation using cardiovascular magnetic resonance imaging (CMR). Blood plasma samples from the femoral vein were collected before AF ablation. NT‐proANP was analyzed using commercially available assays. LVAs were determined using high‐density maps during catheter ablation and defined as <0.5 mV. The novel ANP score (one point for A ge ≥ 65 years, N T‐proANP > 17 ng/mL, and P ersistent AF) was calculated at baseline. Results The study population included 156 AF patients (64 ± 10 years, 65% males, 61% persistent AF, 28% LVAs). The cut‐off ANP score ≥ 2 demonstrated 77% sensitivity and 70% specificity. On logistic regression (odds ratio [OR] 3.469) and receiver operating characteristic (ROC) analysis (area under the curve [AUC] 0.778, P < .001), the ANP score significantly predicted LVAs presence. There were no differences between novel ANP score – which is a new one ‐ is described in the Abstract; with APPLE (AUC 0.718, P = .378) and DR‐FLASH (AUC 0.766, P = .856) scores. Conclusions The novel biomarker‐based ANP score demonstrates good prediction of LVAs.