Key result
An increase in circulating HSP70 levels ≥0.025 ng/ml following catheter ablation for atrial fibrillation was associated with a significantly higher risk of AF recurrence (OR 3.733).
Observational (n=101)
No
Odds Ratio: 3.733 (95% CI 1.026–13.589)
Absolute Event Rate: 32% vs 11%
p-value: p=0.046
Increases in circulating HSP70 and anti-HSP70 antibodies after AF catheter ablation are associated with higher AF recurrence rates in univariate analysis, suggesting a potential role of auto-immune responses in AF progression.
Post-ablation HSP70 rise should not yet guide monitoring or therapy; leaves open autoimmune mechanisms and need for prospective trials.
BACKGROUND: This pilot study investigated the association between heat shock protein 70 (HSP70) and anti-HSP70 antibodies as well as their changes and rhythm outcome after atrial fibrillation (AF) catheter ablation. METHODS: We studied 67 patients with AF (59±11 years, 66% male, 66% lone AF) undergoing catheter ablation. Circulating HSP70 and anti-HSP70 antibody levels were quantified using commercially available assays before and 6 months after catheter ablation. Serial 7-day Holter ECGs were used to detect AF recurrences. RESULTS: At baseline, HSP70 was detectable in 14 patients (21%), but there was no correlation between clinical or echocardiographic variables and the presence or the level of HSP70. In contrast, patients with paroxysmal AF (n=39) showed lower anti-HSP70 antibodies (median [IQR] of 43 [28 - 62] μg/ml) than patients with persistent AF (n=28; 53 [41 - 85] μg/ml, p=0.035). Using multivariable regression analysis, AF type was the only variable associated with anti-HSP70 antibodies (Beta=0.342, p=0.008). At 6 months, HSP70 was present in 27 patients (41%, p<0.001 vs. baseline). Similarly, there was an increase of anti-HSP70 antibodies (48 [36 - 72] vs. 57 [43 - 87] μg/ml, p<0.001). AF recurrence rates were higher in patients with HSP70 increase ≥0.025 ng/ml (32 vs. 11%, p=0.038) or anti-HSP70 increase ≥2.5 μg/ml (26 vs. 4%, p=0.033). CONCLUSIONS: HSP70 and anti-HSP70 antibodies may - at least in part - be associated in the progression of AF and AF recurrence after catheter ablation.
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Kornej et al. (2013) conducted an observational in Atrial fibrillation (n=101). HSP70 increase ≥0.025 ng/ml vs. HSP70 increase <0.025 ng/ml was evaluated on Atrial fibrillation recurrence between 3 and 6 months (OR 3.733, 95% CI 1.026-13.589, p=0.046). An increase in circulating HSP70 levels ≥0.025 ng/ml following catheter ablation for atrial fibrillation was associated with a significantly higher risk of AF recurrence (OR 3.733).
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