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Big endothelin-1 as a predictor of atrial fibrillation recurrence after primary ablation only in patients with paroxysmal atrial fibrillation

Big-Endothelin-1 als Prädiktor rezidivierenden Vorhofflimmerns nach primärer Ablation nur bei Patienten mit paroxysmalem Vorhofflimmern

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Abstract

Background

Atrial fibrillation (AF) recurrence after ablation is difficult to predict. The development of AF is associated with inflammation, and inflammatory markers such as big endothelin-1 (big ET-1) reflect inflammatory status. It is unknown, however, whether big ET-1 can be used as a predictor for AF recurrence. The aim of this study was to investigate the relationship between plasma levels of big ET-1 and AF recurrence.

Methods

A total of 158 patients who had undergone primary ablation for symptomatic and/or drug-refractory AF, including 103 with paroxysmal and 55 with persistent AF, were included in this study. Left atrial diameter was measured with echocardiography and plasma big ET-1 levels with ELISA. All patients were followed up for at least 12 months and AF recurrence defined as an episode of AF lasting ≥ 30 s, with or without atrial flutter or atrial tachycardia.

Results

The AF recurrence rate was 44.9% (71/158) during the median follow-up period of 22 (13, 40) months. Plasma levels of big ET-1 in the recurrence group were higher than those in the non-recurrence group in all patients [0.80 (0.54, 1.30) vs. 0.57 (0.48, 0.72) fmol·L− 1, p  = 0.001], in patients with paroxysmal AF [0.81 (0.46, 1.30) vs. 0.57 (0.48, 0.70) fmol·L− 1, p  = 0.009] as well as in patients with persistent AF [0.77 (0.57, 1.28) vs. 0.57 (0.49, 0.89) fmol·L− 1, p = 0.034]. Multiple logistic regression analyses showed that plasma levels of big ET-1 were associated with AF recurrence in patients with paroxysmal AF (p  = 0.037). Kaplan-Meier analysis demonstrated that the sinus rhythm maintenance rate was lower in patients with higher big ET-1 levels than those with lower levels (p  < 0.05).

Conclusions

Baseline plasma big ET-1 levels are associated with AF recurrence after primary ablation procedure in patients with paroxysmal AF, and may be used in the prediction of AF recurrence in these patients.

Zusammenfassung

Hintergrund

Das Wiederauftreten von Vorhofflimmern (VF) nach Ablation ist schwer vorherzusagen. VF ist mit Entzündungsprozessen vergesellschaftet, und Entzündungsmarker wie Big-Endothelin-1 (Big-ET-1) spiegeln den Entzündungsstatus wider. Es ist jedoch nicht bekannt, ob Big-ET-1 als Prädiktor des Wiederauftretens von VF verwendet werden kann. Ziel dieser Studie war die Untersuchung der Beziehung zwischen Big-ET-1-Plasmaspiegel und einem VF-Rezidiv.

Methoden

An der Studie nahmen insgesamt 158 Patienten mit Zustand nach primärer Ablation wegen symptomatischem und/oder pharmakotherapieresistentem VF teil, darunter 103 mit paroxysmalem und 55 mit persistierendem VF. Der Durchmesser des linken Vorhofs wurde echokardiographisch und der ET-1-Plasmaspiegel per ELISA-Test ermittelt. Alle Patienten wurden mindestens 12 Monate lang nachbeobachtet, ein VF-Rezidiv war als VF-Episode ≥ 30 s definiert, mit oder ohne Vorhofflattern oder Vorhoftachykardie.

Ergebnisse

Die VF-Rezidivrate betrug 44,9% (71/158) im Lauf der mittleren Nachbeobachtungszeit von 22 (13–44) Monaten. In der Rezidivgruppe waren die ET-1-Plasmaspiegel höher als in der Gruppe ohne Rezidiv, und zwar bei allen Patienten [0,80 (0,54–1,30) vs. 0,57 (0,48–0,72) fmol/l, p = 0,001], bei Patienten mit paroxysmalem VF [0,81 (0,46–1,30) vs. 0,57 (0,48–0,70) fmol/l, p = 0,009] sowie bei Patienten mit persistierendem VF [0,77 (0,57–1,28) vs. 0,57 (0,49–0,89) fmol/l, p = 0,034]. Multiple logistische Regressionsanalysen zeigten, dass bei Patienten mit paroxysmalem VF ein Zusammenhang zwischen dem ET-1-Plasmaspiegel und dem VF-Rezidiv bestand (p = 0,037). Die Kaplan-Meier-Analyse ergab, dass die Sinusrhythmuserhaltungsrate bei Patienten mit höheren ET-1-Spiegeln geringer war als bei Patienten mit niedrigeren Spiegeln (p < 0,05).

Schlussfolgerungen

Bei Patienten mit paroxysmalem VF und Zustand nach primärer Ablation stehen die Ausgangswerte von ET-1 im Plasma in Zusammenhang mit dem Wiederauftreten von VF und können bei solchen Patienten zur Vorhersage eines VF-Rezidivs eingesetzt werden.

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On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. The First Affiliated Hospital of Bengbu Medical College, 233004, Bengbu, People’s Republic of China

    H. Wang

  2. State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037, Beijing, People’s Republic of China

    J. Liu, P. Fang, S. Lei, X. Li, Y. Hou & S. Zhang

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  1. H. Wang
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  2. J. Liu
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  3. P. Fang
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  4. S. Lei
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  6. Y. Hou
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  7. S. Zhang
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Correspondence to J. Liu.

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Wang, H., Liu, J., Fang, P. et al. Big endothelin-1 as a predictor of atrial fibrillation recurrence after primary ablation only in patients with paroxysmal atrial fibrillation. Herz 37, 919–925 (2012). https://doi.org/10.1007/s00059-012-3626-9

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  • DOI: https://doi.org/10.1007/s00059-012-3626-9

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