Predictive value of HMGB1 for atrial fibrillation recurrence after catheter ablation in paroxysmal atrial fibrillation patients

Abstract

Background: To evaluate the clinical efficacy of serum high-mobility group box-1 (HMGB1) released from the left atrium to predict atrial fibrillation (AF) recurrence in paroxysmal AF (pAF) patients after catheter ablation (CA) at 1-year follow-up.Methods: We included 72 pAF patients who underwent CA. To determine the expression levels of HMGB1, left atrial blood samples were collected from the patients prior to CA and after the procedure through the transseptal sheath placed into the left atrium. Patients were followed-up for AF recurrence after 1 year of CA.Results: A total of 19 (26%) patients of the 72 experienced AF recurrence. No significant differences were noted in the clinical baseline data between the AF recurrence and AF nonrecurrence groups. The level of postoperative HMGB1 (HMGB1post) was higher in the AF recurrence group than in the AF nonrecurrence group (298.51µg/L vs. 278.17 µg/L; P = 0.03). However, no differences were noted in the levels of other biomarkers such as preoperative high-sensitivity C-reactive protein (hs-CRPpre), postoperative hs-CRP (hs-CRPpost), and preoperative HMGB1 (HMGB1pre) between the two groups. Multiple logistic regression analysis revealed that a higher level of serum HMGB1post from the left atrium (HMGB1post: ≥279.35 µg/L) was an independent predictor of AF recurrence (odds ratio [OR]: 5.29 [1.17–23.92], P = 0.04). Receiver operating characteristic (ROC) analysis revealed that HMGB1post had a moderate predictive power for AF recurrence (area under the curve [AUC]: 0.68; sensitivity: 72%; specificity: 68%). The 1-year AF-free survival was significantly lower in patients with a high serum HMGB1post level than in those with a low HMGB1post level (hazard ratio [HR]: 3.81 [1.49–9.75], P = 0.005). Conclusion: In pAF patients who underwent CA, the level of HMGB1 from the left atrium immediately after CA was associated with AF recurrence and demonstrated a moderate predictive power. Thus, we offer a potential predictor to identify pAF patients at high risk of AF recurrence.