Key result
High BNP, severe TR, and intraprocedural arrhythmias predict post-PVI AF recurrence in normal-sized atria.
Why the study?
Enlarged left atrium predicts atrial fibrillation recurrence after pulmonary vein isolation, but recurrences still occur in patients with normal left atrial diameter, leaving predictors in this population unclear.
Cohort (n=168)
No
p-value: p=0.002, 0.047, and 0.001
In patients with normal left atrial diameter undergoing pulmonary vein isolation, high BNP, severe tricuspid regurgitation, and intraprocedural AF/AT relapses independently predict AF recurrence.
May identify higher AF recurrence risk after PVI despite normal LA diameter; extends known predictors beyond LA enlargement but remains hypothesis-generating.
BACKGROUND: Enlarged left atrium (LA) is an established predictor of recurrence of atrial fibrillation (AF) after pulmonary vein isolation (PVI), but occasionally recurrences of AF/atrial tachycardia (AT) are experienced in patients with normal left atrial diameter. Therefore, the predictors of AF recurrence and AF triggers were evaluated in patients with normal LA. METHODS: We enrolled 168 patients with normal LA (<40 mm) who underwent PVI. Various predictors were compared, including age, gender, coronary risk factors, brain natriuretic peptide (BNP), medications, echocardiographic parameters, and procedure parameters, between recurrence and nonrecurrence groups. RESULTS: The recurrence group consisted of 50 patients (29.8%). A univariate analysis demonstrated that the ratio of females, high BNP levels, severe tricuspid valve regurgitation (TR), and relapses of AF/AT during catheter ablation (CA) were significantly higher in the recurrence group. Multivariate analyses showed that a high BNP, severe TR, and AF/AT relapses during CA were independent factors associated with AF recurrence. During the second CA sessions, nonpulmonary vein (PV) triggers were therapeutic targets in 18 patients (46.2%), which was higher than that previously reported. CONCLUSION: A high BNP, severe TR and AF/AT relapses during CA may be correlated with AF recurrence after PVI in the patients with normal LA.
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Yano et al. (2019) conducted a cohort in Atrial fibrillation (n=168). High BNP, severe tricuspid regurgitation, and AF/AT relapses during ablation vs. Absence of these risk factors was evaluated on AF/AT recurrence after pulmonary vein isolation (p=0.002, 0.047, and 0.001). High BNP levels, severe tricuspid regurgitation, and relapses of AF/AT during catheter ablation were identified as independent predictors of atrial fibrillation recurrence after pulmonary vein isolation in patients with normal left atrial diameter.
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