Predictors of atrial fibrillation recurrence in patients with metabolic syndrome after pulmonary vein isolation

Abstract

Aim. To determine the role of biomarkers in predicting atrial fibrillation (AF) recurrence within 12 months after radiofrequency ablation (RFA) in patients with metabolic syndrome (MS).Material and methods. The study included 245 patients with AF aged 35 to 65 years: patients without MS components (n=32), with 1-2 MS components (n=62) and patients with 3 or more MS components (n=153). All patients underwent a comprehensive clinical and anamnestic, anthropometric, laboratory and echocardiographic examinations. The prospective follow-up for 12 months included 135 patients with AF who underwent RFA.Results. It was found that the presence of 3 or more MS components increased the risk of AF recurrence by 4,1 times within 12 months after RFA (relative risk (RR) =4,1, 95% CI 2,19-7,65, p<0,0001). According to binomial logistic regression, epicardial fat thickness (EFT) (OR =3,71, 95% CI 2,12-6,73, p=0,00001), the severity of left atrial fibrosis (OR =1,48, 95% CI 1,03-1,78, p=0,0006), concentrations of galectin-3 (OR =1,31, 95% CI 1,12-1,51, p=0,0001) and GDF-15 (OR =1,11, 95% CI 1,02-1,18, p=0,0002) in patients with AF and MS increase the risk of AF recurrence after RFA. For galectin-3, GDF-15, and EFT, using ROC analysis, the following threshold values were established, the excess of which had the greatest effect on the risk of AF recurrence after RFA in patients with MS: galectin-3 >11,0 ng/ml (RR =3,43, 95% CI 1,79-6,58, p=0,0001), GDF-15 >1380,7 pg/ml (RR =2,84, 95% CI 1,81-4,46, p<0,0001) and EFT >6,4 mm (RR =4,50, 95% CI 2,32-8,71, p<0,0001). In patients with excess of all three biomarker thresholds, the total risk of AF recurrence in patients with MS within 12 months after RFA increases by 3,2 times (RR =3,16, 95% CI 1,97-5,11, p<0,00001).Conclusion. The risk of AF recurrence within 12 months after RFA in patients with three or more MS components is higher than in patients with 1-2 MS components. An increase in the blood concentration of profibrogenic biomarkers galectin-3, GDF-15 and an increase in the thickness of epicardial adipose tissue is associated with an increased risk of AF recurrence in patients with MS, and these biomarkers are likely to play a significant role in predicting recurrent episodes of AF after RFA.

Risk Stratification of Atrial Fibrillation Progression in Patients With Arterial Hypertension and the Ways of Secondary Prevention

“…Следует отметить, что наиболее часто пациенты с АГ и ФП имеют несколько ФР, что значительно увеличивает вероятность прогрессирования аритмии. Так, у пациентов с метаболическим синдромом при наличии ≥3 компонентов риск рецидива ФП после КА в течение 12 месяцев увеличивается в 4,1 раза, а наибольший риск повторных эпизодов данной аритмии выявлен у пациентов с 5 компонентами метаболического синдрома [17].…”

Insights into the Role of Galectin-3 as a Diagnostic and Prognostic Biomarker of Atrial Fibrillation

“…In addition, AF ablation may positively affect LV function in patients with HF [ 80 ]. Biomarkers have been suggested in some instances of AF, e.g., in patients with metabolic syndrome having AF, for which Gal-3 and growth/differentiation factor-15 (GDF-15) were suggested to be predictors of AF recurrence [ 81 ]. This can have implications for personalizing antiarrhythmic medications.…”