N-terminal pro-B-type natriuretic peptide level at long-term follow-up after atrial fibrillation ablation: a marker of reverse atrial remodelling and successful ablation
- 280 Downloads
We investigated the relationship between arrhythmia burden, left atrial volume (LAV) and N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) at baseline and after long-term follow-up of atrial fibrillation (AF) ablation.
We studied 38 patients (23 paroxysmal, 6 women, mean age 56 ± 11) scheduled for AF ablation. LAV was calculated on the basis of computed tomography images at baseline and long-term follow-up, and arrhythmia burden was graded from self-reported frequency and duration of AF episodes.
After a mean period of 22 ± 5 months, 28/38 patients (11/15 persistent) were free from AF recurrence. At baseline there were no differences in mean LAV (125 vs. 130 cm3, p = 0.7) or median NT-pro-BNP (33.5 vs. 29.5 pmol/L, p = 0.9) between patients whose ablation had been successful or otherwise. At long-term follow-up, there was a marked decrease in LAV (105 vs. 134 cm3, p < 0.05) and level of NT-pro-BNP (7 vs. 17.5 pmol/L, p < 0.05) in the successful ablation patients. NT-pro-BNP correlated with LAV both at baseline (r = 0.71, p < 0.001) and at follow-up (r = 0.57, p < 0.001). Arrhythmia burden correlated with both NT-pro-BNP (r = 0.47, p < 0.01) and LAV (r = 0.52, p < 0.01). A decrease in NT-pro-BNP at follow-up of >25% of baseline value had a specificity of 0.89 and a sensitivity of 0.6 (receiver operator characteristics, accuracy 0.82) for ablation success.
NT-pro-BNP correlates with LAV and arrhythmia burden in AF patients and both NT-pro-BNP and LAV decrease significantly after successful ablation. A decrease in NT-pro-BNP of >25% from the baseline value could be useful as a marker of ablation success.
KeywordsAtrial fibrillation Ablation Natriuretic peptide Atrial volume Arrhytmia burden
This study was supported by a grant from the Norwegian Foundation for Health and Rehabilitation.
Conflict of interest
Chen and Solheim received consultant fees from St. Jude Medical, and Peter Schuster was a recipient of Nordic electrophysiological research grant from Biosense Webster.
- 1.Camm, A. J., Kirchhof, P., Lip, G. Y. H., Schotten, U., Savelieva, I., Ernst, S., et al. (2010). Guidelines for the management of atrial fibrillation. The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Developed with the special contribution of the European Heart Rhythm Association (EHRA). Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS). Europace, 12, 1360–1420.PubMedCrossRefGoogle Scholar
- 4.Gaita, F., Caponi, D., Scaglione, M., Montefusco, A., Corleto, A., Di Monte, F., et al. (2008). Long-term clinical results of 2 different ablation strategies in patients with paroxysmal and persistent atrial fibrillation. Circulation: Arrhythmia and Electrophysiology, 1, 269–275.CrossRefGoogle Scholar
- 7.Kojodjojo, P., Peters, N. S., Davies, D. W., & Kanagaratnam, P. (2007). Characterisation of the electroanatomical substrate in human atrial fibrillation: the relationship between changes in atrial volume, refractoriness, wavefront propagation velocities, and AF burden. Journal of Cardiovascular Electrophysiology, 18, 269–275.PubMedCrossRefGoogle Scholar
- 8.Knackstedt, C., Gramley, F., Schimpf, T., Mischke, K., Zarse, M., Plisiene, J., et al. (2008). Association of echocardiographic atrial size and atrial fibrosis in a sequential model of congestive heart failure and atrial fibrillation. Cardiovascular Pathology, 17, 318–324.PubMedCrossRefGoogle Scholar
- 9.Tuinenburg, A. E., Brundel, B. J. J. M., Van Gelder, I. C., Henning, R. H., Van Den Berg, M. P., Driessen, C., et al. (1999). Gene expression of the natriuretic peptide system in atrial tissue of patients with paroxysmal and persistent atrial fibrillation. Journal of Cardiovascular Electrophysiology, 10, 827–835.PubMedCrossRefGoogle Scholar
- 10.Letsas, K. P., Filippatos, G. S., Pappas, L. K., Mihas, C. C., Markou, V., Alexanian, I. P., et al. (2009). Determinants of plasma NT-pro-BNP levels in patients with atrial fibrillation and preserved left ventricular ejection fraction. Clinical Research in Cardiology, 98, 101–106.PubMedCrossRefGoogle Scholar
- 12.Hwang, H. J., Son, J. W., Nam, B.-H., Joung, B., Lee, B., Kim, J.-B., et al. (2009). Incremental predictive value of pre-procedural N-terminal pro-B-type natriuretic peptide for short-term recurrence in atrial fibrillation ablation. Clinical Research in Cardiology, 98, 213–218.PubMedCrossRefGoogle Scholar
- 13.Patton, K. K., Ellinor, P. T., Heckbert, S. R., Christenson, R. H., DeFilippi, C., Gottdiener, J. S., et al. (2009). N-terminal pro-B-type natriuretic peptide is a major predictor of the development of atrial fibrillation: the cardiovascular health study. Circulation, 120, 1768–1774.PubMedCrossRefGoogle Scholar
- 14.Müller, H., Noble, S., Keller, P.-F., Sigaud, P., Gentil, P., Lerch, R., et al. (2008). Biatrial anatomical reverse remodelling after radiofrequency catheter ablation for atrial fibrillation: evidence from real-time three-dimensional echocardiography. Europace, 10, 1073–1078.PubMedCrossRefGoogle Scholar
- 17.Jayam, V. K., Dong, J., Vasamreddy, C. R., Lickfett, L., Kato, R., Dickfeld, T., et al. (2005). Atrial volume reduction following catheter ablation of atrial fibrillation and relation to reduction in pulmonary vein size: an evaluation using magnetic resonance angiography. Journal of Interventional Cardiac Electrophysiology, 13, 107–114.PubMedCrossRefGoogle Scholar
- 22.Degener, S., Pattberg, S. V., Feuersenger, H., Bansmann, P. M., Shin, D. I., Krummenauer, F., et al. (2011). Predictive value of B-type natriuretic peptide levels in patients with paroxysmal and persistent atrial fibrillation undergoing pulmonary vein isolation. Journal of Interventional Cardiac Electrophysiology, 30, 217–225.PubMedCrossRefGoogle Scholar
- 28.Abecasis, J., Dourado, R., Ferreira, A., Saraiva, C., Cavaco, D., Santos, K. R., et al. (2009). Left atrial volume calculated by multi-detector computed tomography may predict successful pulmonary vein isolation in catheter ablation of atrial fibrillation. Europace, 11, 1289–1294.PubMedCrossRefGoogle Scholar