Elsevier

American Heart Journal

Volume 161, Issue 1, January 2011, Pages 197-203
American Heart Journal

Clinical Investigation
Electrophysiology
Natriuretic peptide levels predict recurrence of atrial fibrillation after radiofrequency catheter ablation

https://doi.org/10.1016/j.ahj.2010.09.031Get rights and content

Background

The presence of atrial fibrillation (AF) is related to increased levels of natriuretic peptides. In addition, increased natriuretic peptide levels are predictive of the development of AF. However, the role of natriuretic peptides to predict recurrence of AF after radiofrequency catheter ablation (RFCA) is controversial.

Objective

The study aimed to investigate the role of natriuretic peptides in the prediction of AF recurrence after RFCA for AF.

Methods

Pre-procedural amino-terminal pro-atrial natriuretic peptide (NT-proANP) and amino-terminal-pro-B-type natriuretic peptide (NT-proBNP) plasma levels were determined in 87 patients undergoing RFCA for symptomatic drug-refractory AF. In addition, a comprehensive clinical and echocardiographic evaluation was performed at baseline. Left atrial volumes, left ventricular volumes, and function (systolic and diastolic) were assessed. During a 6-month follow-up period, AF recurrence was monitored and defined as any registration of AF on electrocardiogram or an episode of AF longer than 30 seconds on 24-hour Holter monitoring. The role of natriuretic peptide plasma levels to predict AF recurrence after RFCA was studied.

Results

During follow-up, 66 patients (76%) maintained sinus rhythm, whereas 21 patients (24%) had AF recurrence. Patients with AF recurrence had higher baseline natriuretic peptide levels than patients who maintained sinus rhythm (NT-proANP 3.19 nmol/L [2.55-4.28] vs 2.52 nmol/L [1.69-3.55], P = .030; NT-proBNP 156.4 pg/mL [64.1-345.3] vs 84.6 pg/mL [43.3-142.7], P = .036). However, NT-proBNP was an independent predictor of AF recurrence, whereas NT-proANP was not. Moreover, NT-proBNP had an incremental value over echocardiographic characteristics to predict AF recurrence after RFCA.

Conclusion

Baseline NT-proBNP plasma level is an independent predictor of AF recurrence after RFCA.

Section snippets

Patient population and evaluation

The study population included patients with drug-refractory symptomatic paroxysmal AF and preserved LV systolic function (ejection fraction >50%) who were referred for RFCA. Atrial fibrillation was classified as paroxysmal when episodes were generally self-terminating and lasted no longer than 7 days, according to the American College of Cardiology/American Heart Association/European Society of Cardiology guidelines definitions.11 At admission, a blood sample was obtained to measure natriuretic

Patient characteristics

The present patient population was prospectively included from an ongoing clinical registry.14 Of 140 consecutive patients undergoing catheter ablation for AF, 87 patients were in SR during the baseline blood test and comprised the patient population (70 men [80%], mean age 55.0 ± 9.4 years). None of the patients previously underwent RFCA for AF. Mean duration of AF was 65 ± 60 months and the mean number of antiarrhythmic drugs used was 3.4 ± 1.4 per patient. Mean LA volume index was 42 ± 12

Discussion

The present study investigated the role of natriuretic peptides to predict AF recurrence after RFCA in patients without signs of structural heart disease. The main finding was that pre-procedural NT-proBNP plasma level was an independent predictor of AF recurrence after RFCA. Importantly, NT-proBNP plasma level had an incremental value over echocardiographic parameters to predict the AF recurrence after RFCA.

Conclusion

In patients without signs of overt structural heart disease, baseline NT-proBNP plasma level obtained during SR is an independent predictor of AF recurrence after RFCA. Plasma levels of NT-proBNP may allow detection of subtle cardiac dysfunction/conditions that may not be detected by echocardiography alone.

Disclosures

Martin J. Schalij receives research grants from Boston Scientific (Natick, MA), Medtronic (Minneapolis, MN), and Biotronik (Berlin, Germany). Jeroen J. Bax receives research grants from General Electric Healthcare (Buckinghamshire, UK), Bristol-Myers Squibb Medical Imaging (North Billerica, MA), St Jude Medical (St. Paul, MN), Medtronic, Boston Scientific, Biotronik, and Edwards Lifesciences (Irvine, CA). The remaining authors have no conflicts of interest to disclose.

Acknowledgements

We thank Margreet de Jong for performing the biochemical analyses.

References (28)

  • RossiA. et al.

    Natriuretic peptide levels in atrial fibrillation: a prospective hormonal and Doppler-echocardiographic study

    J Am Coll Cardiol

    (2000)
  • CalkinsH. et al.

    HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures and follow-up. A report of the Heart Rhythm Society (HRS) task force on catheter and surgical ablation of atrial fibrillation developed in partnership with the European Heart Rhythm Association (EHRA) and the European Cardiac Arrhythmia Society (ECAS); in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), and the Society of Thoracic Surgeons (STS). Endorsed and approved by the governing bodies of the American College of Cardiology, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, and the Heart Rhythm Society

    Europace

    (2007)
  • CappatoR. et al.

    Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation

    Circulation

    (2005)
  • VasamreddyC.R. et al.

    Predictors of recurrence following catheter ablation of atrial fibrillation using an irrigated-tip ablation catheter

    J Cardiovasc Electrophysiol

    (2004)
  • Cited by (0)

    View full text