Multiple biomarkers and arrhythmia outcome following catheter ablation of atrial fibrillation: The Guangzhou Atrial Fibrillation Project

Abstract

BackgroundBiomarkers have been related to the arrhythmia recurrence following catheter ablation (CA) of atrial fibrillation (AF). We hypothesized that concurrent measurement of several biomarkers would additively improve their predictive value.MethodsOne thousand four hundred and ten consecutive AF patients (68% male; 57.2 ± 11.6 years) undergoing CA were enrolled. Baseline characteristics, serum B type brain natriuretic peptide (BNP) and high sensitivity C reactive protein (hsCRP), estimated glomerular filtration rate (eGFR), ablation parameters, arrhythmia data at discharge, 1, 3, 6, and then every 6 months post CA were collected. Follow‐up ended when arrhythmia recurred or until 31st December 2016.ResultsThree hundred and sixty‐five (25.9%) patients had arrhythmia recurrence post‐CA during a mean follow‐up of 20.7 ± 8.8 months. BNP, hsCRP, and eGFR levels and their cut‐off values of 237.45 pg/mL, 1.6 mg/dL, and 82.5 mL/min/1.73 m2 were good predictors for AF recurrence (all P < 0.01). On multivariate analysis, increasing BNP and hsCRP, decreasing eGFR, gender, and early recurrence (ER) were independent predictors of AF recurrence (all P < 0.01). Compared to BNP alone, BNP plus eGFR or both eGFR and CRP showed incrementally better predictive values (ROC comparisons, all P < 0.01). Similar findings were evident in the subgroups of patients with paroxysmal or nonparoxysmal AF.ConclusionMeasurement of BNP, CRP, and eGFR were incrementally additive to clinical risk factors in a cumulative manner to improve prediction of arrhythmia recurrence post‐CA of AF. The implications of poor arrhythmia outcome in AF patients with multiple abnormal biomarkers pre‐CA procedure may help with patient selection and inform the likelihood of success or the need of more complicated CA procedure(s).

Clinical Applications of Natriuretic Peptides in Heart Failure and Atrial Fibrillation

“…The cut-off value of BNP for AF recurrence was 237.45 pg/mL. Similar findings were evident in the subgroups of patients with paroxysmal or nonparoxysmal AF [92]. The NT-proBNP level at baseline was an independent predictor of AF recurrence ( p < 0.001) after pulmonary vein isolation with a cut-off value of NT-proBNP of ≥423.2 pg/mL ( p = 0.002) [68].…”

Natriuretic Peptides in the Cardiovascular System: Multifaceted Roles in Physiology, Pathology and Therapeutics

“…In fact, higher cut-off levels of BNP need to be taken into consideration to improve the specificity and likelihood of correct diagnosis of HF in the presence of AF [35]. Moreover, as discussed in this issue, the role of NPs in the screening for the new onset of incident AF and for the prediction of AF recurrence after cardioversion and pulmonary vein isolation may reveal useful in the clinical setting [33,36,37].…”

Predictors of recurrence after pulmonary vein isolation in patients with normal left atrial diameter

“…In this study we showed high BNP level, which reflected promoting LA remodeling, was one of the risk factor for AF recurrence and might cause PV reconnection. Previous reports demonstrated biomarkers such as BNP (NT-proBNP) that were involved in the development and recurrence of AF 22,23. A recent study showed that PV reconnection rate after first PVI was 86% in patients with PAF including various LA dimensions 21.…”