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

May 10, 2011
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Authors:
Hussein AA, Saliba WI, Martin DO, et al.
Citation:
Circulation 2011;123:2077-2082.
Summary By:
Fred Morady, MD, FACC

Study Questions:

Do B-type natriuretic peptide (BNP) levels predict recurrent atrial fibrillation (AF) after radiofrequency catheter ablation (RFCA) of idiopathic AF?

Methods:

Pulmonary vein antral isolation (PVAI) was performed by RFCA in 726 patients (mean age 57 years) with idiopathic AF (paroxysmal in 78%). The plasma BNP level was measured just prior to RFCA. Efficacy was determined with serial clinic visits, event monitors, and 48-hour Holter monitors.

Results:

The median BNP level was 52 pg/ml before RFCA. The BNP level was higher in the 39% of patients who presented in AF than in the patients who presented in sinus rhythm. The BNP level was not associated with recurrent AF during the first 2 months post-ablation. During a median follow-up of 26 months, 79% of patients remained arrhythmia-free. The strongest independent predictor of recurrent AF was an elevated BNP level (hazard ratio [HR], 2.3). The next strongest independent predictors of recurrent AF were persistent AF (HR, 1.9), male gender (HR, 1.4), and presence of AF at the time of RFCA (HR, 1.3). Increasing BNP quintiles were associated with progressively higher AF recurrence rates.

Conclusions:

The preablation BNP level is a strong predictor of recurrent AF after RFCA of idiopathic AF.

Perspective:

Prior studies have demonstrated elevated BNP levels in patients without structural heart disease who have AF. Atrial mechanical dyssynchrony caused by AF could be responsible for the elevation in BNP, and higher BNP levels might reflect more advanced atrial remodeling. This may explain why PVAI was less effective in patients with higher BNP levels, and suggests that more extensive RFCA directed at the atrial substrate might be appropriate when the BNP level is elevated.

Keywords: Heart Diseases, Heart Atria, Follow-Up Studies, Biomarkers, Pulmonary Veins, Electrocardiography, Catheter Ablation, Natriuretic Peptide, Brain


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