The Predictive Value of Growth Differentiation Factor-15 in Recurrence of Atrial Fibrillation after Catheter Ablation

Abstract

The mechanisms underlying the recurrence of atrial fibrillation (AF) after radiofrequency catheter ablation (RFCA) are not well concerned. The study sought to explore the association between growth differentiation factor-15 (GDF-15) and the incidence of recurrent events among AF patients after the ablation procedure. We prospectively included 150 consecutive AF patients who underwent RFCA. Clinical information about the patients was collected. Blood samples on the second morning of hospital admission and three months after RFCA were collected, and enzyme-linked immunosorbent assay (ELISA) was used to measure the concentration of GDF-15. All participants were followed up at specific times (1st/3rd/6th/12th/18th/24th months) after RFCA to record recurrences events. During a median follow-up of 14.0 months, AF recurrence occurred in 37(24.7%) patients. Baseline serum GDF-15 level in the persistent AF group was significantly higher than the paroxysmal AF group [1140(854~1701)ng/L vs. 1062(651~1374)ng/L, P=0.039]. Baseline serum GDF-15 level in the recurrence group was significantly higher than the nonrecurrence group [1287(889~1768) ng/L vs. 1062(694~1373)ng/L, P=0.022]. Serum GDF-15 level at three months after RFCA was significantly lower than the baseline [870 (579~1270) ng/L vs. 1155 (735~1632)ng/L, P<0.001]. The baseline GDF-15 correlated significantly with LAP (r=0.296, P<0.001) and LAAV(r=−0.235, P=0.003). Kaplan-Meier analysis showed a significantly lower event-free survival time in the high baseline GDF-15 (≥1287.3 ng/L) group than the low baseline GDF-15 (<1287.3 ng/L) group (17.1 months vs. 20.4 months, Log Rank P=0.017). In the multivariate Cox regression, baseline GDF-15(HR 1.053, 95% CI 1.007-1.100, P=0.022) and LAD (HR 1.124, 95% CI 1.011-1.250, P=0.030) were independent predictors of AF recurrence after RFCA. Our study indicated increased preprocedural GDF-15 is associated with left atrial remodeling and acts as a predictor of AF recurrence after ablation.

The prognostic significance of left atrial appendage peak flow velocity in the recurrence of persistent atrial fibrillation following first radiofrequency catheter ablation

“…The difference in these findings may be due to the differing baseline variables and conditions for patient participation in the two studies. Our research only excluded patients with AF who had moderate to severe mitral valve disease, while previous studies excluded patients with AF who had any degree of heart valve disease (30); however, we consider our findings more valid since they represent the condition of the vast majority of patients who attend hospital. Secondly, the duration of AF in our sample was longer than in previous research (30).…”

“…Our research only excluded patients with AF who had moderate to severe mitral valve disease, while previous studies excluded patients with AF who had any degree of heart valve disease (30); however, we consider our findings more valid since they represent the condition of the vast majority of patients who attend hospital. Secondly, the duration of AF in our sample was longer than in previous research (30). This could be related to extensive atrial structural remodeling because an enhancement in AF's duration has been correlated with a greater extent of LA fibrosis (35).…”

“…Nevertheless, after 1 year of follow-up, it is unknown if LAAV can still predict AF recurrence in individuals having PeAF who had first RFCA. Following a median follow-up of 14 months, prior research indicating LAAV was not an independent predictor of AF relapse following catheter ablation (30). The median follow-up time was 15 months, with a maximum of 24 months.…”

“…A decreased LAAV enhances the likelihood of recurrence of PeAF following ablation in the 12 months follow-up time following the procedure (26)(27)(28)(29). On the other hand, other research suggests that LAAV is not a reliable predictor of recurrence following catheter ablation of PeAF in all cases (30).…”

Relationship between serum growth differentiation factor 15, fibroblast growth factor-23 and risk of atrial fibrillation: a systematic review and meta-analysis

“…In general, the eligible studies were published from 2011 to 2020, and their sample size ranged from 100 to 3,217 participants. Four studies reported the association between serum GDF-15 level and the risk of AF in the general population [7][8][9]24], 2 studies concentrated on patients who received coronary artery bypass graft [25,26], and 2 studies reported this association in patients with recurrent AF after catheter ablation [27,28]. The majority of the eligible studies were performed in Europe [7, 10, 24-27] (n=6), two studies were undertaken in China [8,28], and only one study was conducted in the United States [9].…”