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

• Published in: Circulation (New York, N.Y.) Vol. 123; no. 19; pp. 2077 - 2082
• Main Authors: HUSSEIN, Ayman A, SALIBA, Walid I, TCHOU, Patrick, LINDSAY, Bruce D, NATALE, Andrea, WAZNI, Oussama M, MARTIN, David O, SHADMAN, Mazyar, KANJ, Mohamed, BHARGAVA, Mandeep, DRESING, Thomas, MINA CHUNG, CALLAHAN, Thomas, BARANOWSKI, Bryan
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 17-05-2011
• Subjects: Aged; Arrhythmias, Cardiac - blood; Arrhythmias, Cardiac - epidemiology; Atrial Fibrillation - diagnosis; Atrial Fibrillation - surgery; Biological and medical sciences; Biomarkers - blood; Blood and lymphatic vessels; Cardiology. Vascular system; Catheter Ablation; Coronary heart disease; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Follow-Up Studies; Heart; Humans; Linear Models; Male; Medical sciences; Middle Aged; Natriuretic Peptide, Brain - blood; Predictive Value of Tests; Prognosis; Recurrence; Retrospective Studies; Risk Factors; natriuretic peptides; Arrhythmia; Heart disease; Atrial fibrillation; Catheter; Cardiovascular disease; catheter ablation; Ablation; Excitability disorder
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circulationaha.110.007252

Plasma B-type natriuretic peptide (BNP) is abnormally elevated in patients with lone atrial fibrillation (AF). The exact significance and prognostic implications of this elevation have yet to be determined. Little is known about BNP in lone AF patients undergoing arrhythmia ablation. We sought to determine the relationship between BNP levels and the risk of recurrent arrhythmia after ablation of lone AF.
We followed up 726 patients with lone AF undergoing first-time arrhythmia ablation. All had BNP levels measured on the day of ablation with of the point-of-care Triage Meter assay (Biosite Diagnostics, San Diego, CA). At baseline, factors associated with elevated BNP levels in multivariable linear regression analysis (with log BNP being the dependent variable) were older age (β regression coefficient for +1-year change, 0.025; P<0.0001), longer duration of AF (β for +1-year change, 0.031; P=0.01), nonparoxysmal AF (versus paroxysmal; β, 0.52; P<0.0001), and larger left atrial size (β for +1-cm(2) change, 0.040; P<0.0001). The BNP levels were strongly associated with arrhythmia recurrence in univariate- (hazard ratio for +1-log-BNP change, 2.32; 95% confidence interval, 2.11 to 2.74; P<0.001) and covariate- (hazard ratio for +1-log-BNP change, 2.13; 95% confidence interval, 2.06 to 2.38; P<0.001) adjusted Cox proportional hazards analysis. The covariate-adjusted hazard ratios for recurrent arrhythmia were 1.6, 2.7, 4.3, and 5.7 for the second, third, fourth, and fifth quintiles, respectively, compared with patients in the lowest quintile (P for trend across quintiles <0.001).
B-type natriuretic peptide levels correlate with AF burden (chronicity, altered hemodynamics, and anatomic remodeling) in patients with lone AF and are strong predictors of recurrent arrhythmia after ablation. Elevated BNP levels may reflect increased cardiac chamber wall stress and/or intrinsic atrial disease, thus increasing the risk of arrhythmia recurrence.