Serum relaxin level predicts recurrence of atrial fibrillation after radiofrequency catheter ablation

  • Xiang Qu
  • Lingzhi Chen
  • Lingyue Sun
  • Changxi Chen
  • Zhan Gao
  • Weijian Huang
  • Hao ZhouEmail author
Original Article


Relaxin, an emerging biomarker in heart failure, is involved in fibrosis and inflammation. The value of relaxin in predicting recurrence of atrial fibrillation (AF) after radiofrequency catheter ablation (RFCA) is unknown and the subject of this study. We prospectively enrolled 248 consecutive patients with AF (paroxysmal in 127 and persistent in 121) who underwent RFCA at our center after measurement of circulating levels of relaxin by ELISA. Kaplan–Meier analysis with log-rank test and multivariate analysis were used to assess the association between pre-RFCA relaxin levels and post-RFCA AF recurrence at 18 months follow-up. At mean 16.3 ± 3.8 months post-RFCA, 195 (78.6%) patients maintained sinus rhythm, and their pre-RFCA relaxin level was lower than that in patients with AF recurrence (P < 0.001). From lowest to highest pre-RFCA relaxin level tertiles (T1; 82.10–< 234.36; T2; 234.36–< 342.26; and T3; 342.26–740.63 ng/L), AF recurrence rate increased significantly (8.5%, 20.5% and 34.9%, respectively; Kaplan–Meier analysis with log-rank test, χ2 = 18.44, P < 0.001). Using a cutoff of 285.4 ng/L, pre-RFCA relaxin level predicted AF recurrence during follow-up with sensitivity of 77.4% and specificity of 55.9% (area under the receiver operating characteristic curve = 0.71). On multivariate Cox proportional hazard model, relaxin level by tertile (T2, hazard ratio 2.678; 95% confidence interval 1.110–6.460; P = 0.028, and T3, hazard ratio 4.745; 95% confidence interval 2.075–10.854; P < 0.001, respectively compared with the T1) was the independent factor predicting recurrence. Elevated pre-RFCA relaxin level is associated with post-RFCA AF recurrence. A simple measurement of relaxin level therefore might help identify patients at high risk of AF recurrence after RFCA.

Clinical Trial Registration identifier: ChiCTR-OOC-15006130.


Atrial fibrillation Ablation Recurrence Relaxin 



Atrial fibrillation


Radiofrequency catheter ablation

Ang II

Renin–angiotensin–aldosterone system and angiotensin II


Paroxysmal atrial fibrillation


Persistent atrial fibrillation




Estimated glomerular filtration rate


Brain natriuretic peptide


Left atrial diameter


Left ventricular mass index


Receiver operating characteristic


Confidence interval


Area under the ROC curve


Hazard ratio


Odds ratio


Extracellular matrix


Left atrial


Low-density lipoprotein cholesterol


Left ventricular end-diastolic diameter



This research was supported by the National Natural Science Foundation of China [81570364, 81873468] and in part by the Science and Technology Planning Project of Wenzhou Science & Technology Bureau of Zhejiang Province of China [Y20150032, Y20160318, Y20170021].The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. No additional external funding received for this study.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to disclose. No commercial party having a direct or indirect interest in the subject matter of this research conferred a benefit on the authors or on any organization with which the authors are associated. This material has not previously been presented in any form.


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Copyright information

© Springer Japan KK, part of Springer Nature 2019

Authors and Affiliations

  • Xiang Qu
    • 1
    • 2
  • Lingzhi Chen
    • 1
    • 2
  • Lingyue Sun
    • 3
  • Changxi Chen
    • 1
    • 2
  • Zhan Gao
    • 1
    • 2
  • Weijian Huang
    • 1
    • 2
  • Hao Zhou
    • 1
    • 2
    Email author
  1. 1.Department of Cardiovascular MedicineThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina
  2. 2.The Key Lab of Cardiovascular Disease of WenzhouWenzhouChina
  3. 3.Department of Cardiology, Ren Ji Hospital, School of MedicineShanghai Jiao Tong UniversityShanghaiChina

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