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Predictive value of B-type natriuretic peptide levels in patients with paroxysmal and persistent atrial fibrillation undergoing pulmonary vein isolation

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Abstract

Background

Atrial fibrillation (AF) is the most common cardiac arrhythmia reducing the health-related quality of life. Radiofrequency catheter ablation (CA) became the therapy of choice in patients with drug-resistant AF with success rates between 30% and 86%. However, CA remains a challenging intervention with major complications in about 5% of cases. Therefore, stratification into high and low success patient groups would be helpful. The aim of this study was to investigate the predictive value of B-type natriuretic peptide (BNP) on the outcome of pulmonary vein isolation (PVI) in patients with paroxysmal (PAF) and persistent (Pers-AF) atrial fibrillation.

Materials and methods

In 73 patients (median age 53 years, 77% men) undergoing PVI for drug-refractory PAF (n = 45) or Pers-AF (n = 28), the serum BNP concentration was measured before and 3 months after the ablation procedure to assess any association of pre- and post-interventional BNP concentrations with therapeutic outcome. The patients had suffered from AF for a median of 40 months. No patient had structural heart disease or an impaired left-ventricular ejection fraction.

Results

A total of 54 patients (74%) had stable sinus rhythm 3 months after PVI. The median baseline BNP levels in both PAF and Pers-AF patients were significantly lower in patients with a 3-month successful PVI than those in which it was unsuccessful, 57.5 pg/ml (20.4–87.9) versus 159.0 pg/ml (124.1–177.5; p = 0.001) in PAF patients and 90.3 pg/ml (41.0–155.0) versus 176 pg/ml (89.6–297.4; p = 0.026) in patients with Pers-AF, respectively. A multiple logistic regression analysis identified pre-interventional BNP levels as the only independent predictor for 3-month PVI outcomes (p = 0.010). Nevertheless, in this study, the predictive value of BNP for PVI outcomes was not high enough to permit individual outcome prediction.

After successful PVI, BNP levels were significantly lower in patients with PAF and Pers-AF (median changes −16.9 and −23.8 pg/ml; p = 0.010 and p = 0.022, respectively), but not in patients with AF in follow-up (median change 9.0 pg/ml and −29.6 pg/ml; p = 1.000 and p = 0.109, respectively).

Conclusion

Pre-ablation BNP level seems to be an independent marker for successful PVI procedures in patients with paroxysmal and persistent AF; however, the observed level of association is moderate.

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Authors and Affiliations

  1. Department of Cardiology and Electrophysiology, University of Witten/Herdecke, Medical Center Porz am Rhein, Urbacher Weg 19, 51149, Cologne, Germany

    Stephan Degener, Sarah V. Pattberg, Dong-In Shin & Marc Horlitz

  2. Department of Radiology, Medical Center Porz am Rhein, Urbacher Weg 19, 51149, Cologne, Germany

    Paul M. Bansmann

  3. Department of Medical Biometry and Epidemiology, University of Witten/Herdecke, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany

    Henrike Feuersenger & Frank Krummenauer

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  1. Stephan Degener
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Correspondence to Marc Horlitz.

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Degener, S., Pattberg, S.V., Feuersenger, H. et al. Predictive value of B-type natriuretic peptide levels in patients with paroxysmal and persistent atrial fibrillation undergoing pulmonary vein isolation. J Interv Card Electrophysiol 30, 217–225 (2011). https://doi.org/10.1007/s10840-010-9540-2

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  • DOI: https://doi.org/10.1007/s10840-010-9540-2

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