A predictive model using left atrial function and B‐type natriuretic peptide level in predicting the recurrence of early persistent atrial fibrillation after radiofrequency ablation

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Early persistent atrial fibrillation undergoing first circular pulmonary vein ablation (n=215). Intervention: Combined predictive model of RT-3DE left atrial function parameters (diastolic ejection index and left atrial appendage peak emptying velocity) and preoperative blood BNP level vs. Preoperative blood BNP level alone. Primary outcome: Predictive discrimination (AUC) for recurrence of atrial fibrillation (documented atrial arrhythmia episode >=30 seconds after a 3-month blanking period, up to 6 months post-ablation) (AUC 0.814 vs. 0.703 (z = 2.224), 95% CI 0.749-0.874, p=0.026).

Q: What does this research mean for the field?

A combined prediction model integrating real-time 3D echocardiography left atrial function parameters with preoperative BNP levels predicts early persistent atrial fibrillation recurrence after ablation more accurately than BNP alone. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Zhenni Yang; Min Xu; Chuxu Zhang; Huannian Liu; Xiaoliang Shao; Yuetao Wang; Ling Yang; Junhua Yang

doi:10.1002/clc.23557

February 8, 2021Clinical CardiologyOpen Access

A predictive model using left atrial function and B‐type natriuretic peptide level in predicting the recurrence of early persistent atrial fibrillation after radiofrequency ablation

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Key result

Adding RT-3DE LA function to BNP improves post-ablation AF recurrence prediction, reaching AUC ~0.81.

AUC 0.814 vs. 0.703 (z = 2.224)
95% CI 0.749-0.874
P=0.026
n=215

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Why the study?

To evaluate the value of a predictive model combining RT-3DE-derived left atrial function indexes and blood BNP level in predicting recurrence after radiofrequency ablation in early persistent AF.

Does a combined predictive model using RT-3DE left atrial function parameters (DEI, LAAV) and preoperative blood BNP level improve the prediction of atrial fibrillation recurrence compared to BNP alone in patients with early persistent AF undergoing circular pulmonary vein ablation?

Key Points

To construct and validate a predictive model combining left atrial function indexes obtained via real-time three-dimensional echocardiography and blood B-type natriuretic peptide levels to predict recurrence after radiofrequency ablation in early persistent atrial fibrillation.
Enrolled 228 patients with early persistent atrial fibrillation scheduled for initial circular pulmonary vein ablation, with 215 patients completing ablation and a 3- to 6-month follow-up.
Measured preoperative blood B-type natriuretic peptide levels and obtained left atrial time-volume curves using real-time three-dimensional echocardiography.
Constructed a multivariable logistic regression model incorporating functional indexes and evaluated diagnostic performance using receiver operating characteristic curve analysis.
During 3 to 6 months of follow-up, 55 patients (25.6%) experienced atrial fibrillation recurrence while 160 patients remained in sinus rhythm.
The recurrence group demonstrated significantly higher minimum left atrial volume index, diastolic ejection index, and preoperative B-type natriuretic peptide (all p ≤ .001), alongside lower expansion index and left atrial appendage peak emptying velocity (p ≤ .001).
While B-type natriuretic peptide alone yielded an AUC of 0.703, the combined multivariable prediction model achieved significantly superior discrimination for recurrence (AUC: 0.814 vs. 0.703, z = 2.224, p = .026).

Study Design

Type

Cohort (n=215)

Multicenter

No

Structured PICO

Does a combined predictive model using RT-3DE left atrial function parameters (DEI, LAAV) and preoperative blood BNP level improve the prediction of atrial fibrillation recurrence compared to BNP alone in patients with early persistent AF undergoing circular pulmonary vein ablation?

P

Population

215 adults (aged 18-75 years, 16.3% female) in China with early persistent atrial fibrillation (>7 days to <3 months duration) and LVEF >=50% undergoing first circular pulmonary vein ablation, followed for 3 to 6 months.

E

Exposure

Combined multivariate logistic regression prediction model incorporating preoperative real-time three-dimensional echocardiography (RT-3DE) left atrial function parameters (diastolic ejection index [DEI]), transesophageal echocardiography left atrial appendage peak emptying velocity (LAAV), and preoperative venous blood B-type natriuretic peptide (BNP) level: Logit(P) = 2.805 - 8.953 DEI + 0.003 BNP - 0.058 LAAV.

C

Comparator

Single-factor prediction models using preoperative blood BNP level alone (or individual echocardiographic parameters DEI, LAAV, and minimum left atrial volume index [LAVImin]). All patients received post-operative non-vitamin K antagonist oral anticoagulants for at least 2 months and antiarrhythmic drugs (amiodarone 200 mg once daily, propafenone 150 mg three times daily, moricizine 150 mg three times daily, or sotalol 80 mg twice daily) for 3 months.

O

Outcome

Recurrence of atrial fibrillation (defined as a documented episode of any atrial arrhythmia including AF, atrial tachycardia, or atrial flutter lasting >=30 seconds on monthly ECG or 24-hour Holter monitoring) after the 3-month blanking period during 3 to 6 months of follow-up, evaluated by receiver operating characteristic (ROC) area under the curve (AUC).hard clinical

Main Result

Effect estimate: AUC 0.814 vs. 0.703 (z = 2.224) (95% CI 0.749-0.874)

Absolute Event Rate: 0.814% vs 0.703%

p-value: p=0.026

Limitations

Echocardiographic measurements in continuous AF may be biased due to heart rate and varying ventricular filling times despite averaging multiple cardiac cycles
Short follow-up duration of 3 to 6 months, excluding AF recurrence occurring after 6 months
Lack of long-term continuous cardiac rhythm monitoring after ablation, potentially missing occasional asymptomatic AF episodes
Small sample size with only internal bootstrap validation and no external validation cohort
Echocardiographic data measured during continuous AF may be biased by heart rate and varying ventricular filling times despite averaging across five cardiac cycles
Follow-up was limited to 3-6 months, so AF recurrence after 6 months was not evaluated
Long-term continuous cardiac rhythm monitoring was not performed after ablation, meaning occasional AF episodes may have been missed
Small sample size relying on internal Bootstrap resampling (500 iterations) without a separate validation cohort or external verification

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Implication

Combining preoperative RT-3DE left atrial functional indices (DEI and LAAV) with serum BNP levels significantly improves risk stratification for short-term AF recurrence following radiofrequency ablation in patients with early persistent AF.

Abstract

AIM: A predictive model using left atrial function indexes obtained by real-time three-dimensional echocardiography (RT-3DE) and the blood B-type natriuretic peptide (BNP) level was constructed, and its value in predicting recurrence in patients with early persistent atrial fibrillation (AF) after radiofrequency ablation was explored. METHODS: A total of 228 patients with early persistent AF who were scheduled to receive the first circular pulmonary vein ablation (CPVA) were enrolled. Clinical data of patients were collected: (1) The blood BNP level was measured before radiofrequency ablation; (2) RT-3DE was used to obtain the left atrial (LA) time-volume curve; (3) The clinical characteristics, BNP level and LA function parameters were compared, and logistic regression was used to construct a prediction model with combined parameters; (4) The receiver operating characteristic (ROC) curve was used to examine the diagnostic efficacy of the model. RESULTS: (1) 215 patients with early persistent AF completed CPVA and the follow-up. After 3-6 months of follow-up, the patients were divided into sinus rhythm group (160 cases) and recurrence group (55 cases); (2) The recurrence group showed higher minimum LA volume index, diastolic ejection index, and preoperative BNP (all p ≤ .001), while the sinus rhythm group exhibited higher expansion index (PI) and left atrial appendage peak emptying velocity (p ≤ .001); (3) In univariate analysis, BNP level had the best diagnostic performance in predicting the recurrence of AF(AUC = 0.703). We constructed a model based on LA function and BNP level to predict the recurrence of persistent AF after CPVA. This combined model was better than BNP alone in predicting the recurrence of persistent AF after CPVA (AUC: 0.814 vs. 0.703, z = 2.224, p = .026). CONCLUSION: The combined model of LA function and blood BNP level has good predictive value for the recurrence of early persistent AF after CPVA.

Discussion

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Cite This Study

Yang et al. (2021) conducted a cohort in Early persistent atrial fibrillation undergoing first circular pulmonary vein ablation (n=215). Combined predictive model of RT-3DE left atrial function parameters (diastolic ejection index and left atrial appendage peak emptying velocity) and preoperative blood BNP level vs. Preoperative blood BNP level alone was evaluated on Predictive discrimination (AUC) for recurrence of atrial fibrillation (documented atrial arrhythmia episode >=30 seconds after a 3-month blanking period, up to 6 months post-ablation) (AUC 0.814 vs. 0.703 (z = 2.224), 95% CI 0.749-0.874, p=0.026). A combined model of RT-3DE left atrial function and preoperative BNP outperformed BNP alone in predicting early persistent AF recurrence after ablation (AUC 0.814 vs 0.703, p=0.026).

synapsesocial.com/papers/6a72ff57c5a6515d7e9a3162 https://doi.org/10.1002/clc.23557

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A predictive model using left atrial function and B‐type natriuretic peptide level in predicting the recurrence of early persistent atrial fibrillation after radiofrequency ablation

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

A predictive model using left atrial function and B‐type natriuretic peptide level in predicting the recurrence of early persistent atrial fibrillation after radiofrequency ablation

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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