Key result
Elevated venous MPO and NT-proANP predict intermediate AF recurrence after redo ablation with ~0.75 AUC.
Why the study?
Electroanatomic remodeling may drive AF recurrence, motivating investigation into whether potential biomarkers (MPO, NT-proANP, ICAM-1, and MMP-2) predict AF recurrence after redo ablation.
Cohort (n=50)
No
Pre-ablation plasma levels of MPO and NT-proANP are acceptable predictors of atrial fibrillation recurrence in patients undergoing redo ablation, correlating with endocardial fibrosis and left atrial volume, respectively.
May refine recurrence risk assessment after redo ablation; leaves open prospective validation before practice change.
BACKGROUND Atrial fibrillation (AF) is a progressively developing arrhythmia.Electroanatomic remodeling may play an important role, both in the development of the disease and in the perpetuation and thus in the recurrence of AF. OBJECTIVEThis study aimed to investigate potential biomarkers myeloperoxidase (MPO), N-terminal proatrial natriuretic peptide (NT-proANP), intercellular adhesion molecule-1, and matrix metalloproteinase-2 and their predictive value for AF recurrence in patients undergoing redo ablation.METHODS In this single-center prospective cohort study, 50 consecutive patients underwent ultra high-density mapping and redo ablation.Biomarkers were determined before ablation and at 6-month follow-up.Seven-day Holter was conducted to check for AF recurrence (.30 seconds).RESULTS Eleven (22%) patients showed AF recurrence after redo ablation.Receiver-operating characteristic curve analysis revealed venous MPO and NT-proANP (area under the curve [AUC] 0.755, 95% CI 0.599-0.912,P 5 .010;and AUC 0.752, 95% CI 0.551-0.953,P 5 .011)as acceptable predictors for intermediate AF recur-rence, whereas matrix metalloproteinase-2, intercellular adhesion molecule-1, and established cardiovascular biomarkers such as Nterminal pro-B-type natriuretic peptide, troponin T, and C-reactive protein were not (all AUC ,0.600).MPO and NT-proANP correlated with AF burden (r 5 0.365, P 5 .005;and r 5 0.362, P 5 .005).While MPO was associated with atrial fibrosis in the endocardial map (r 5 0.280, P 5 .024),NT-proANP correlated with left atrial volume index (r 5 0.256, P 5 .037).There were no significant differences in biomarkers concentrations with regard to venous and coronary sinus samples.CONCLUSION MPO and NT-proANP are of predictive value for AF recurrence in patients undergoing redo ablation.While MPO correlated with endocardial fibrosis, NT-proANP was associated with left atrial volume.
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Bannehr et al. (2024) conducted a cohort in Atrial fibrillation (n=50). Elevated pre-ablation myeloperoxidase (MPO) and N-terminal proatrial natriuretic peptide (NT-proANP) vs. Lower levels of MPO and NT-proANP was evaluated on Recurrence of AF defined as atrial tachycardia (AT)/AF >30 seconds in 7-day Holter or cardioversion within the study period after 3 months of blanking (AUC 0.755, 95% CI 0.599-0.912, p=.010). Venous MPO and NT-proANP were acceptable predictors for intermediate AF recurrence after redo ablation, with AUCs of 0.755 and 0.752, respectively.
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