Plasma B-Type Natriuretic Peptide Levels and Recurrent Arrhythmia After Successful Ablation of Lone Atrial Fibrillation

Abstract

Background-Plasma B-type natriuretic peptide (BNP) is abnormally elevated in patients with lone atrial fibrillation (AF).The exact significance and prognostic implications of this elevation have yet to be determined. Little is known about BNP in lone AF patients undergoing arrhythmia ablation. We sought to determine the relationship between BNP levels and the risk of recurrent arrhythmia after ablation of lone AF. Methods and Results-We followed up 726 patients with lone AF undergoing first-time arrhythmia ablation. All had BNP levels measured on the day of ablation with of the point-of-care Triage Meter assay (Biosite Diagnostics, San Diego, CA). At baseline, factors associated with elevated BNP levels in multivariable linear regression analysis (with log BNP being the dependent variable) were older age (␤ regression coefficient for ϩ1-year change, 0.025; PϽ0.0001), longer duration of AF (␤ for ϩ1-year change, 0.031; Pϭ0.01), nonparoxysmal AF (versus paroxysmal; ␤, 0.52; PϽ0.0001), and larger left atrial size (␤ for ϩ1-cm 2 change, 0.040; PϽ0.0001). The BNP levels were strongly associated with arrhythmia recurrence in univariate-(hazard ratio for ϩ1-log-BNP change, 2.32; 95% confidence interval, 2.11 to 2.74; PϽ0.001) and covariate-(hazard ratio for ϩ1-log-BNP change, 2.13; 95% confidence interval, 2.06 to 2.38; PϽ0.001) adjusted Cox proportional hazards analysis. The covariate-adjusted hazard ratios for recurrent arrhythmia were 1.6, 2.7, 4.3, and 5.7 for the second, third, fourth, and fifth quintiles, respectively, compared with patients in the lowest quintile (P for trend across quintiles Ͻ0.001). Conclusions-B-type natriuretic peptide levels correlate with AF burden (chronicity, altered hemodynamics, and anatomic remodeling) in patients with lone AF and are strong predictors of recurrent arrhythmia after ablation. Elevated BNP levels may reflect increased cardiac chamber wall stress and/or intrinsic atrial disease, thus increasing the risk of arrhythmia recurrence.

Which are the most reliable predictors of recurrence of atrial fibrillation after transcatheter ablation?: a meta-analysis

“…From the 3475 citations first screened, 27 complete reports were evaluated for inclusion in the present research and finally 19 studies were included in the review [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32] and [33] (Fig. 1).…”

Atrial Fibrillation Complexity Parameters Derived From Surface ECGs Predict Procedural Outcome and Long-Term Follow-Up of Stepwise Catheter Ablation for Atrial Fibrillation

“…There is evidence that elevated cardiac biomarkers, such as B-type natriuretic peptide or markers of inflammation, predict ablation outcome. 32,33 Also, the possible predictive value of single-nucleotide variants as shown before was not included in this study. 34 Follow-up data in the validation cohort were available in only 77% of the patients.…”

Elevated Red Blood Cell Distribution Width Predicts Recurrence After Catheter Ablation for Atrial Fibrillation in Patients With Heart Failure – Comparison With Non-Heart Failure Patients –

“…Moreover, BNP levels at baseline were relatively widely distributed in the HF patients, so temporal BNP levels may be less likely to predict the recurrence of AF after CA than in lone AF patients. 27 It was also unusual that patients with persistent AF rather than paroxysmal AF in the HF group were likely to have fewer episodes of AF recurrence after ablation in the present study. We speculate that, in the HF group, patients with persistent AF were highly considered for selection for CA than those with paroxysmal AF because of the HF condition, and that the more curable persistent AF in HF patients would be subject to ablation therapy.…”