Impact of epicardial ablation of concomitant atrial fibrillation on atrial natriuretic peptide levels and atrial function in 6 months follow-up: does preoperative ANP level predict outcome of ablation?

Abstract

BackgroundEpicardial ablation concomitant to cardiac surgery is an easy and safe approach to treat atrial fibrillation (AF), but its efficacy in longstanding persistent (LsPe) AF remains intermediate. Although larger left atrial size has been associated with worse outcome after ablation, biochemical predictors of success are not well established. The aim of this study was to evaluate relationship between biochemical marker, echo-characteristic and cardiac rhythm in 6 months follow-up after epicardial ultrasound (HIFU) ablation.MethodsWe included 78 consecutive patients, who underwent elective cardiac surgery. 42 patients with AF (11.9% paroxysmal, 23.8% persistent, 64.3% LsPeAF) underwent concomitant HIFU ablation (AF ablation group), 16 with AF underwent cardiac surgery without ablation (AF control) and 20 had preoperatively normal sinus rhythm (SR control). We measured plasma ANP secretion before, on postoperative day (POD) 1, POD 7 as well as 3 and 6 months after surgery. Moreover, we estimated cardiac rhythm and atrial mechanical function by Atrial Filling Fraction (AFF) and A-wave velocity in follow-up.ResultsBaseline ANP levels were higher in patients with LsPeAF, as compared to the paroxysmal and permanent AF and to the SR control group. Patients with LsPeAF (n = 27) who converted to SR had preoperatively smaller left atrial diameter (LAD) and LA area (p < 0.05) and higher ANP level (p = 0.009) than those who remained in AF at 6 months after ablation. Multivariate regression analysis revealed that only preoperative ANP level was an independent predictor of cardiac rhythm after ablation. Patients with LsPeAF and preoperative ANP >7.5 nmol/l presented with SR in 80%, in contrast to those with ANP <7.5 nmol/l who converted to SR in 20%. We detected gradual increase of AFF and A-velocity at 6 months after ablation (p < 0.05) solely in AF ablation group. ANP levels were increased on POD 1 in ablation group (p < 0.05), without changes in further follow-up.ConclusionOur results indicate that preoperative ANP levels may be a new biochemical predictor of successful epicardial ablation in patients with concomitant LsPeAF. HIFU ablation caused a significant improvement of atrial mechanical function and gradual increase of AFF and did not associate with alteration of atrial endocrine secretion at 6 months follow-up.

Pulmonary Veins Epicardial Isolation with High-Intensity Focused Ultrasounds for the Treatment of Non-Primary Atrial Fibrillation

“…At 3 and 6 months remained in SR 66.7% and 100% of patients with paroxysmal AF, 100% and 90% of patients with persistent AF and 33.3% and 56% of patients with permanent AF. As predictors of the ablation outcome, Pizón found that patients who maintained sinus SR had a smaller left atrial diameter and a smaller left atrial area [32]. In our study, the variables that were related to maintenance of SR at first year were Euroscore and the size of left atrium in the univariate analysis, while in multivariate analysis were paraxismal AF, age and male gender.…”

Atrial Natriuretic Peptides as a Bridge between Atrial Fibrillation, Heart Failure, and Amyloidosis of the Atria

“…An interesting finding that emerged from the studies is the kinetics of ANP after catheter ablation. These data [ 48 ] showed that there was a transient increase in ANP levels shortly after the procedure that gradually decreased thereafter. These observations suggest that direct damage to atrial cells releases more ANP.…”

“…A study by Nakanishi et al [ 49 ] suggests that in patients with AF, undergoing catheter ablation, increased ANP levels are associated with favorable atrial remodeling. Similarly, a study of epicardial AF ablation [ 48 ] showed that in patients with long-standing persistent AF, increased ANP levels were associated with persistence of the sinus rhythm despite a low success rate. Conversely, a meta-analysis [ 50 ] showed that higher ANP levels were an independent predictor of AF recurrence, but only in patients without structural heart disease.…”