Key result
The presence of three abnormal pre-ablation biomarkers (TSH, FT4, and BNP) was associated with a higher risk of arrhythmia recurrence after AF ablation (HR 2.88; 95% CI 1.39-5.17; p=0.003).
Why the study?
Although Ablation Index software has improved AF ablation results, recurrence rates remain significant, and the ability of pre-ablation serum biomarkers to predict recurrence after AI-guided ablation required evaluation.
Can pre-ablation serum biomarkers predict arrhythmia recurrence in patients undergoing AI-guided AF ablation?
Observational (n=593)
Yes
Can pre-ablation serum biomarkers predict arrhythmia recurrence in patients undergoing AI-guided AF ablation?
A combination of abnormal TSH, FT4, and BNP values prior to ablation can independently predict arrhythmia recurrence after AI-guided AF ablation.
Biomarkers may aid recurrence prediction after AI-guided AF ablation; leaves open need for validation before clinical use.
Background: Ablation Index (AI) software has allowed better atrial fibrillation (AF) ablation results, but recurrence rates remain significant. Specific serum biomarkers have been associated with this recurrence. Objectives: To evaluate whether certain biomarkers could be used (either individually or combined) to predict arrhythmia recurrence after AI-guided AF ablation. Methods: Prospective multicenter observational study of consecutive patients referred for AF ablation from January 2018 to March 2021. Hemoglobin, brain natriuretic peptide (BNP), C-reactive protein, high sensitivity cardiac troponin I, creatinine clearance, thyroid-stimulating hormone (TSH) and free thyroxine (FT4) were assessed for their ability to predict arrhythmia recurrence during follow-up. Statistical significance was accepted for p values of<0.05. Results: A total of 593 patients were included - 412 patients with paroxysmal AF and 181 with persistent AF. After a mean follow-up of 24±6 months, overall single-procedure freedom from atrial arrhythmia was 76.4%. Individually, all biomarkers had no or only modest predictive power for recurrence. However, a TSH value >1.8 μUI/mL (HR=1.82 [95% CI, 1.89-2.80], p=0.006) was an independent predictor of arrhythmia recurrence. When assessing TSH, FT4 and BNP values in combination, each additional “abnormal” biomarker value was associated with a lower freedom from arrhythmia recurrence (87.1 % for no biomarker vs. 83.5% for one vs. 75.1% for two vs. 43.3% for three biomarkers, p<0.001). Patients with three “abnormal” biomarkers had a threefold higher risk of AF recurrence compared with no “abnormal” biomarker (HR=2.88 [95% CI, 1.39-5.17], p=0.003). Conclusions: When used in combination, abnormal TSH, FT4 and BNP values can be a useful tool for predicting arrhythmia recurrence after AI-guided AF ablation.
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Palma et al. (2024) conducted an observational in Atrial fibrillation (n=593). Three abnormal pre-ablation biomarkers (TSH, FT4, BNP) vs. No abnormal biomarkers was evaluated on Arrhythmia recurrence (HR 2.88, 95% CI 1.39-5.17, p=0.003). The presence of three abnormal pre-ablation biomarkers (TSH, FT4, and BNP) was associated with a higher risk of arrhythmia recurrence after AF ablation (HR 2.88; 95% CI 1.39-5.17; p=0.003).
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