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Elevated brain natriuretic peptide level in patients undergoing atrial fibrillation ablation: is it a predictor of failed ablation or a mere function of atrial rhythm and rate at a point in time?

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Abstract

Background

Pre- and postablation atrial fibrillation (AF) brain natriuretic peptide (BNP) levels were shown to predict increased recurrence of AF following ablation.

Objective

Our objective was to assess whether elevated BNP levels merely represent the presence of AF at the time of measurement or indeed the true recurrence of AF.

Methods and Results

In a prospective study of 88 patients undergoing AF ablation, BNP levels were measured immediately before, after, 24 h, and 4–6 months postablation. BNP levels were stratified by presenting rhythm and ventricular rate at the time of measurement. Median BNP level preablation was higher in patients presenting in AF compared to sinus rhythm (SR) (54(44–79) pg/ml vs. 30(18–47) pg/ml, p < 0.001). Postablation restoration of SR in patients presenting in AF reduced median BNP levels from 54(44–79) pg/ml to 40(37–51) pg/ml, (p < 0.001). However, no change was noted in patients who presented in and maintained SR throughout the procedure (30(18–47) pg/ml to 27(16–40) pg/ml, p = 0.270). At 4–6 months, BNP measured in patients in SR was not significantly different from postablation BNP (35(22–53) pg/ml vs. 38(20–52) pg/ml, p = 0.656), although 35 % of them had AF recurrence in 1-year follow-up. Median BNP level measured in five patients while in atrial arrhythmia was elevated compared to postablation BNP (464(421–464) pg/ml to 37(36–37) pg/ml, p = 0.043). BNP levels and ventricular rates are positively correlated at all times pre- and postablation.

Conclusions

BNP level rises acutely during AF and with rapid ventricular rates. BNP level seems to be a function of atrial rhythm and ventricular rate rather than short- or long-term predictor of AF ablation success.

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Abbreviations

BNP:

Brain natriuretic peptide

AF:

Atrial fibrillation

SR:

Sinus rhythm

PVAI:

Pulmonary vein antral isolation

AFL:

Atrial flutter

AAD:

Antiarrhythmic drugs

OSA:

Obstructive sleep apnea

ACEI/ARB:

Angiotensin converting enzyme inhibitor/angiotensin receptor blocker

References

  1. Levin, E. R., Gardner, D. G., & Samson, W. K. (1998). Natriuretic peptides. New England Journal of Medicine, 339, 321–328.

    Article  CAS  PubMed  Google Scholar 

  2. Silvet, H., Young-Xu, Y., Walleigh, D., & Ravid, S. (2003). Brain natriuretic peptide is elevated in outpatients with atrial fibrillation. American Journal of Cardiology, 92, 1124–1127.

    Article  CAS  PubMed  Google Scholar 

  3. Tsuchida, K., & Tanabe, K. (2004). Influence of paroxysmal atrial fibrillation attack on brain natriuretic peptide secretion. Journal of Cardiology, 44, 1–11.

    PubMed  Google Scholar 

  4. Beck-da-Silva, L., de Bold, A., Fraser, M., Williams, K., & Haddad, H. (2004). Brain natriuretic peptide predicts successful cardioversion in patients with atrial fibrillation and maintenance of sinus rhythm. Canadian Journal of Cardiology, 20, 1245–1248.

    CAS  PubMed  Google Scholar 

  5. Vinch, C. S., Rashkin, J., Logsetty, G., Tighe, D. A., Hill, J. C., Meyer, T. E., et al. (2004). Brain natriuretic peptide levels fall rapidly after cardioversion of atrial fibrillation to sinus rhythm. Cardiology, 102, 188–193.

    Article  CAS  PubMed  Google Scholar 

  6. Ohta, Y., Shimada, T., Yoshitomi, H., Inoue, S., Murakami, Y., Shimizu, H., et al. (2001). Drop in plasma brain natriuretic peptide levels after successful direct current cardioversion in chronic atrial fibrillation. Canadian Journal of Cardiology, 17, 415–420.

    CAS  PubMed  Google Scholar 

  7. Haissaguerre, M., Jais, P., Shah, D. C., et al. (1998). Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. New England Journal of Medicine, 339, 659–666.

    Article  CAS  PubMed  Google Scholar 

  8. Jais, P., Sanders, P., Hsu, L. F., Hosini, M., & Haissaguerre, M. (2005). Catheter ablation for atrial fibrillation. Heart, 91, 7–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Kurosaki, K., Tada, H., Hashimoto, T., Ito, S., Miyaji, K., Naito, S., et al. (2007). Plasma natriuretic peptide concentrations as a predictor for successful catheter ablation in patients with drug-refractory atrial fibrillation. Circulation Journal, 71, 313–320.

    Article  CAS  PubMed  Google Scholar 

  10. Date, T., Yamane, T., Inada, K., Matsuo, S., Miyanaga, S., Sugimoto, K., et al. (2006). Plasma brain natriuretic peptide concentrations in patients undergoing pulmonary vein isolation. Heart, 92, 1623–1627.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Yamada, T., Murakami, Y., Okada, T., Yoshida, N., Toyama, J., Yoshida, Y., et al. (2007). Plasma brain natriuretic peptide level after radiofrequency catheter ablation of paroxysmal, persistent, and permanent atrial fibrillation. Europace, 9(9), 770–774.

    Article  PubMed  Google Scholar 

  12. Yamada, T., Murakami, Y., Okada, T., Yoshida, N., Toyama, J., Yoshida, Y., et al. (2008 Mar). Plasma brain natriuretic peptide level after hybrid therapy with pulmonary vein isolation and antiarrhythmic drugs for atrial fibrillation. International Heart Journal, 49(2), 143–151.

  13. Hussein, A. A., Saliba, W. I., Martin, D. O., Shadman, M., Kanj, M., Bhargava, M., et al. (2011). Plasma B-type natriuretic peptide levels and recurrent arrhythmia after successful ablation of lone atrial fibrillation. Circulation, 123(19), 2077–2082.

    Article  CAS  PubMed  Google Scholar 

  14. Shin, D. I., Deneke, T., Gorr, E., Anders, H., Buenz, K., Paesler, M., et al. (2009). Predicting successful pulmonary vein isolation in patients with atrial fibrillation by brain natriuretic peptide plasma levels. Indian Pacing Electrophysiology Journal, 9, 241–246.

    PubMed Central  PubMed  Google Scholar 

  15. 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.

    Article  CAS  PubMed  Google Scholar 

  16. Mohanty, S., Mohanty, P., Di Biase, L., Rong, B., Burkhardt, D., Gallinghouse, J. G., et al. (2011). Baseline B-type natriuretic peptide: a gender-specific predictor of procedure-outcome in atrial fibrillation patients undergoing catheter ablation. Journal of Cardiovascular Electrophysiology, 22(8), 858–865.

    Article  PubMed  Google Scholar 

  17. McKie, P. M., & Burnett, J. C., Jr. (2005). B-type natriuretic peptide as a biomarker beyond heart failure: speculations and opportunities. Mayo Clinic Proceedings, 80, 1029–1036.

    Article  CAS  PubMed  Google Scholar 

  18. Redfield, M. M., Rodeheffer, R. J., Jacobsen, S. J., Mahoney, D. W., Bailey, K. R., & Burnett, J. C., Jr. (2002). Plasma brain natriuretic peptide concentration: impact of age and gender. Journal of the American College of Cardiology, 40, 976–982.

    Article  CAS  PubMed  Google Scholar 

  19. Callahan, T. D., 4th, Di Biase, L., Horton, R., Sanchez, J., Gallinghouse, J. G., & Natale, A. (2009). Catheter ablation of atrial fibrillation. Cardiology Clinics, 27, 163–178.

    Article  PubMed  Google Scholar 

  20. http://www.biosite.com/products/bnp.aspx. last accessed 4/3/10

  21. Oral, H., Knight, B. P., Ozaydin, M., Tada, H., Chugh, A., Hassan, S., et al. (2002). Clinical significance of early recurrences of atrial fibrillation after pulmonary vein isolation. Journal of the American College of Cardiology, 40, 100–104.

    Article  PubMed  Google Scholar 

  22. Gerbes, A. L., Dagnino, L., Nguyen, T., & Nemer, M. (1994). Transcription of brain natriuretic peptide and atrial natriuretic peptide genes in human tissues. Journal of Clinical Endocrinology and Metabolism, 78, 1307–1311.

    CAS  PubMed  Google Scholar 

  23. Wasywich, C. A., Webster, M. W., Richards, A. M., & Stewart, R. A. (2006). Coronary sinus and ascending aortic levels of aldosterone, angiotensin II, and B-type natriuretic peptide in patients with aortic stenosis and in patients with coronary heart disease. American Journal of Cardiology, 97, 1068–1072.

    Article  CAS  PubMed  Google Scholar 

  24. Mukoyama, M., Nakao, K., Saito, Y., Ogawa, Y., Hosoda, K., Suga, S., et al. (1990). Human brain natriuretic peptide, a novel cardiac hormone. Lancet, 335, 801–802.

    Article  CAS  PubMed  Google Scholar 

  25. Inoue, S., Murakami, Y., Sano, K., Katoh, H., & Shimada, T. (2000). Atrium as a source of brain natriuretic polypeptide in patients with atrial fibrillation. Journal of Cardiac Failure, 6, 92–96.

    Article  CAS  PubMed  Google Scholar 

  26. Qi, W. F., Kjekshus, H. F., Klinge, R. F., kjekshus, J. K., & Hall, C. (2000). Cardiac natriuretic peptides and continuously monitored atrial pressures during chronic rapid pacing in pigs. Acta Physiologica Scandinavica, 169, 95–102.

    Article  CAS  PubMed  Google Scholar 

  27. Magioncalda, A., Sartini, M., Costaguta, C., Castellaneta, M., Schenone, E., Tognoni, E., et al. (2008). The utility of assaying the N-terminal of brain natriuretic peptide precursor (NT pro-BNP) to predict the clinical outcome in patients with supraventricular tachyarrhythmias observed and treated in the emergency room. Recenti Progressi in Medicina, 99, 141–145.

    PubMed  Google Scholar 

  28. Chen, L., Wei, T., Zeng, C., Chen, Q., Shi, Z., & Wang, L. (2005). Effect of radiofrequency catheter ablation on plasma B-type natriuretic peptide. Pacing and Clinical Electrophysiology, 28(3), 200–204.

    Article  PubMed  Google Scholar 

  29. Vanga, S., Pillarisetti, J., Biria, M., Rajoli, S., Pimentel, R., Lakkireddy, D. (2010). Overcoming Fluid Overload After Atrial Fibrillation Ablation with an Open Irrigated Catheter: Role of Scheduled Diuresis and Electrolyte Replacement. Heart Rhythm Supplement 7:pO-06 58. (Abs)

  30. Li, J., & Wang, L. (2006). B-type natriuretic peptide levels in patients with paroxysmal lone atrial fibrillation. Heart and Vessels, 21, 137–140.

    Article  PubMed  Google Scholar 

  31. Kim, B. J., Hwang, S. J., Sung, K. C., et al. (2007). Assessment of factors affecting plasma BNP levels in patients with chronic atrial fibrillation and preserved left ventricular systolic function. International Journal of Cardiology, 118, 145–150.

    Article  PubMed  Google Scholar 

  32. Yamada, T., Murakami, Y., Okada, T., Kim, B. S., Kang, J. H., Lee, M. H., et al. (2006). Plasma atrial natriuretic peptide and brain natriuretic peptide levels after radiofrequency catheter ablation of atrial fibrillation. American Journal of Cardiology, 97, 1741–1744.

    Article  CAS  PubMed  Google Scholar 

  33. Wazni, O. M., Martin, D. O., Marrouche, N. F., Okamoto, M., Shimizu, T., Toyama, J., et al. (2004). Plasma B-type natriuretic peptide levels predict postoperative atrial fibrillation in patients undergoing cardiac surgery. Circulation, 110, 124–127.

    Article  CAS  PubMed  Google Scholar 

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Conflict of interests

No specific conflict of interests related to the study for any of the authors.

Author information

Authors and Affiliations

  1. Division of Cardiology-KU Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS, 66195, USA

    Jayasree Pillarisetti, Namratha Reddy, Mazda Biria, Darbhamulla Nagarajan, Caroline Murray, Donita Atkins, Sudharani Bommana, Madhu Yeruva Reddy, Rhea Pimentel, Loren Berenbom, Buddhadeb Dawn & Dhanunjaya Lakkireddy

  2. Ryschon Consulting LLC, Omaha, NE, USA

    Kay Ryschon

  3. Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA

    Luigi DiBiase & Andrea Natale

  4. Center for Excellence in Atrial Fibrillation & Electrophysiology Research, Bloch Heart Rhythm Center—Mid America Cardiology, 3901 Rainbow Blvd, Kansas City, KS, 66195, USA

    Dhanunjaya Lakkireddy

Authors
  1. Jayasree Pillarisetti
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  2. Namratha Reddy
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  9. Madhu Yeruva Reddy
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  10. Luigi DiBiase
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  13. Buddhadeb Dawn
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  14. Andrea Natale
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  15. Dhanunjaya Lakkireddy
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Corresponding author

Correspondence to Dhanunjaya Lakkireddy.

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Pillarisetti, J., Reddy, N., Biria, M. et al. Elevated brain natriuretic peptide level in patients undergoing atrial fibrillation ablation: is it a predictor of failed ablation or a mere function of atrial rhythm and rate at a point in time?. J Interv Card Electrophysiol 40, 161–168 (2014). https://doi.org/10.1007/s10840-014-9898-7

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  • DOI: https://doi.org/10.1007/s10840-014-9898-7

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