Left atrial voltage, circulating biomarkers of fibrosis, and atrial fibrillation ablation. A prospective cohort study

Abstract

AimsTo test the ability of four circulating biomarkers of fibrosis, and of low left atrial voltage, to predict recurrence of atrial fibrillation after catheter ablation.BackgroundCirculating biomarkers potentially may be used to improve patient selection for atrial fibrillation ablation. Low voltage areas in the left atrium predict arrhythmia recurrence when mapped in sinus rhythm. This study tested type III procollagen N terminal peptide (PIIINP), galectin-3 (gal-3), fibroblast growth factor 23 (FGF-23), and type I collagen C terminal telopeptide (ICTP), and whether low voltage areas in the left atrium predicted atrial fibrillation recurrence, irrespective of the rhythm during mapping.Methods92 atrial fibrillation ablation patients were studied. Biomarker levels in peripheral and intra-cardiac blood were measured with enzyme-linked immunosorbent assay. Low voltage (<0.5mV) was expressed as a proportion of the mapped left atrial surface area. Follow-up was one year. The primary endpoint was recurrence of arrhythmia. The secondary endpoint was a composite of recurrence despite two procedures, or after one procedure if no second procedure was undertaken.ResultsThe biomarkers were not predictive of either endpoint. After multivariate Cox regression analysis, high proportion of low voltage area in the left atrium was found to predict the primary endpoint in sinus rhythm mapping (hazard ratio 4.323, 95% confidence interval 1.337–13.982, p = 0.014) and atrial fibrillation mapping (hazard ratio 5.195, 95% confidence interval 1.032–26.141, p = 0.046). This effect was also apparent for the secondary endpoint.ConclusionThe studied biomarkers do not predict arrhythmia recurrence after catheter ablation. Left atrial voltage is an independent predictor of recurrence, whether the left atrium is mapped in atrial fibrillation or sinus rhythm.

Galectin‐3 and risk of atrial fibrillation: A systematic review and meta‐analysis

“…Among the 38 full‐text articles assessed for eligibility, ten were excluded for the following reasons: One study lacked a control group; one study population was heart failure; four studies lacked available data for further analysis; and four reported duplicate data from studies that later published as full text . Finally, 28 studies involving 10 830 patients were included in our meta‐analysis, with their baseline characteristics shown in Tables and .…”

Noninvasive assessment of left atrial fibrosis. Correlation between echocardiography, biomarkers, and electroanatomical mapping

“…27,28 Reports on the use of biomarkers in predicting successful ablation are inconsistent as well as only partially positive. [29][30][31] The most positive results were observed in patients with nonparoxysmal AF and enlarged LA. 32 We did not observe any relationship between biomarkers of fibrosis and LAPA both in SR and AF, although our SR subgroup consisted mainly of paroxysmal AF patients with normal or slightly enlarged LA and AF subgroup was very small.…”

“…and AF. [29][30][31] The most positive results were observed in patients with nonparoxysmal AF and enlarged LA. Therefore, it cannot be used for selecting candidates for RFCA or establishing prognosis prior to procedure.…”

Elevated β1-Adrenergic Receptor Autoantibody Levels Increase Atrial Fibrillation Susceptibility by Promoting Atrial Fibrosis

“…Nevertheless, other studies failed to verify the correlation between these biomarkers and fibrosis as assessed by LA low-voltage area (Begg et al, 2017). A convincing explanation is that the blood levels of fibrosisrelated biomarkers are susceptible to non-cardiac fibrosis, and systemic fibrosis masks their peripheral levels (Begg et al, 2018). In our study, we pre-excluded patients with severe heart failure and those with autoimmune or infectious diseases; only patients newly diagnosed with PAF were included.…”