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Association between left atrial appendage emptying velocity, N-terminal plasma brain natriuretic peptide levels, and recurrence of atrial fibrillation after catheter ablation

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Abstract

Purpose

Multiple studies have shown the efficacy and potentially curative effect of catheter ablation (CA). However, CA is always accompanied by a considerable recurrence rate for atrial fibrillation (AF). We hypothesized that pre-procedure assessments of baseline left atrial appendage emptying flow velocity (LAAFV) and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels would help identify abnormal atrial substrate and offer preliminary evidence regarding susceptibility to AF recurrence in patients with paroxysmal or persistent AF, respectively.

Methods

In 120 patients with AF (paroxysmal, 55; persistent, 65), transesophageal echocardiography was performed with assessment of LAAFV and NT-proBNP was measured before the first AF ablation.

Results

After 12 months of follow-up, 16 patients (29.1%) in the paroxysmal AF and 23 patients (35.4%) in the persistent AF experienced recurrence of AF. In ROC analysis, a NT-proBNP value of ≥291 pg/ml in the paroxysmal AF and ≥368 pg/ml in the persistent AF discriminated AFR and non-AFR with the greatest sensitivity and specificity. In multivariate regression analysis, LAAFV (OR 0.88, 95% CI 0.79–0.98, p = 0.023) was identified as an independent predictor of AFR in the paroxysmal AF population post-CA after adjustment for other risk factors; however, in the persistent AF population, LAAFV (OR 0.81, 95% CI 0.68–0.94, p = 0.007) and a NT-proBNP value ≥368 pg/ml (OR 18.29, 95% CI 1.32–252.84, p = 0.030) were identified as independent predictors for rhythm outcome compared to other parameters.

Conclusions

In patients with persistent AF, elevated plasma NT-proBNP concentrations combined with low LAAFV were associated with rhythm outcome after AF ablation; however, LAAFV was the only independent predictor of CA efficacy in patients with paroxysmal AF.

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Authors and Affiliations

  1. Department of Ultrasound in Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, No. 600 Yishan Road, Shanghai, 200233, China

    Xin-Xin Ma, Yue-Li Zhang, Bing Hu, Wen-Jun Jiang, Man Wang, Dong-Yan Zheng, Meng-Ruo Zhu & Xiao-Pei Xue

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  1. Xin-Xin Ma
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Correspondence to Yue-Li Zhang.

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The authors declare that they have no competing interests.

Funding

The study was supported by a research grant from the Shanghai Science and Technology Commission (Fund no. 134119a5801).

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Ma, XX., Zhang, YL., Hu, B. et al. Association between left atrial appendage emptying velocity, N-terminal plasma brain natriuretic peptide levels, and recurrence of atrial fibrillation after catheter ablation. J Interv Card Electrophysiol 48, 343–350 (2017). https://doi.org/10.1007/s10840-016-0216-4

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  • DOI: https://doi.org/10.1007/s10840-016-0216-4

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