Evaluation of selected fibrosis markers and echocardiography parameters in patients with atrial fibrillation treating cryoablation - perspectives of clinical use

PURPOSE: Atrial fibrillation is one of the most common arrhythmias, affecting 1-2% of the population worldwide. Pulmonary vein isolation by cryoballoon ablation is an established treatment strategy; however, arrhythmia recurrence remains a challenge. The aim of this study was to evaluate fibrosis-related biomarkers and advanced echocardiographic parameters in patients undergoing cryoablation and assess their role in predicting AF recurrence. PATIENTS AND METHODS: The study included 91 patients with AF treated with cryoablation at the Department of Cardiology, University Hospital in Bialystok, Poland. Before the procedure, blood samples were collected for laboratory analyses, and transthoracic echocardiography with assessment of left atrial (LA) mechanics was performed. Patients underwent a 12-month follow-up to evaluate sinus rhythm maintenance. RESULTS: AF recurrence occurred in 31 patients (34%). Significant differences between the AF and control groups were found in galectin-3 concentration (p = 0.021), total cholesterol (p = 0.004), HDL cholesterol (p < 0.001), left ventricular diameter (p = 0.007), left ventricular ejection fraction (p < 0.01), and LA strain during conduit, reservoir, and active pump phases (all p < 0.001). No differences were observed between patients with and without AF recurrence. CONCLUSIONS: A classification tree model incorporating left atrial reservoir strain, body mass index, LA diameter, and age identified variables potentially associated with arrhythmia recurrence. Although these findings require validation in larger cohorts, they suggest that combining clinical and echocardiographic parameters may improve risk stratification. Advanced echocardiographic techniques and fibrosis-related biomarkers may contribute to assessment of atrial remodeling, although their prognostic value remains uncertain.