Impaired Atrial Natriuretic Peptide Secretion as a Marker of Advanced Atrial Fibrillation

Figures

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  Central Figure.

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  Figure 1.. A trial natriuretic peptide (ANP)/B-type natriuretic peptide (BNP) ratio during atrial fibrillation and left atrial low voltage. (A) Receiver operating characteristic curve analysis reveals that the optimal cut-off value of the ANP/BNP ratio during atrial fibrillation is 0.7 for predicting the presence of a left atrial low-voltage zone. The diagnostic performance is significantly superior to that of ANP alone (P<0.001) and left atrial volume index (LAVI; P=0.001). (B) Receiver operating characteristic curve analysis reveals that the optimal cut-off value of the ANP/BNP ratio during sinus rhythm was 0.6 for predicting the presence of a left atrial low-voltage zone. Although not statistically significant, the diagnostic performance is superior to that of ANP alone (P=0.051) and LAVI (P=0.098).

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  Figure 2.. Representative cases and atrial low-voltage zones of each group. In these left atrial high-density voltage maps of representative cases with and without impaired atrial natriuretic peptide (ANP) secretion, the color gradation indicates serial changes in the electrogram amplitude, from purple at 0.5 mV to grey at 0.1 mV, as shown in the color bar on the left of the figure. The percentage of patients with low-voltage zone (LVZ) presence among all participants (n=166; top bar graph) and the mean size of the LVZ among patients with LVZs (n=58; bottom bar graph) in each group are also shown. Patients with atrial fatigue (ANP/B-type natriuretic peptide [BNP] ratio ≤0.7) showed a significantly higher presence and larger size of LVZ than those with an ANP/BNP ratio >0.7.

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  Figure 3.. Kaplan-Meier analysis of the primary outcome. The cumulative incidence of atrial arrhythmia recurrences after catheter ablation was compared between the atrial fatigue group and the control group using Kaplan-Meier analysis. The patients with atrial fatigue (ANP/BNP ratio ≤0.7) has a worse arrhythmic prognosis both (A) after the first ablation procedure (within 3 years) and (B) after a repeat ablation procedure (within 2 years). ANP, atrial natriuretic peptide; BNP, B-type natriuretic peptide.