Bone Morphogenetic Protein-10 as a Predictor of Atrial Fibrillation Recurrence After Catheter Ablation: A Systematic Review and Meta-Analysis

Background: Biomarkers of atrial cardiomyopathy may improve the prediction of recurrence of atrial fibrillation (AF) after catheter ablation. Bone morphogenetic protein-10 (BMP10) is an atrial-specific cardiomyocyte protein and a potential biomarker, but evidence is limited and not comprehensively synthesized. Methods: We performed a systematic review and meta-analysis of prospective cohort studies to evaluate the association between circulating BMP10 concentrations with AF recurrence after catheter ablation. Pooled hazard ratios (HRs) with corresponding 95% confidence intervals (CIs) were computed using a random-effects model. The primary analysis used unadjusted HRs per continuous BMP10 levels from all included studies. Secondary analyses were conducted based on the adjusted HRs of studies with continuous BMP10 and all studies, including one study that reported adjusted HRs based on quartiles. Results: Three studies were included. In the primary analysis without adjustment (n = 3), increased levels of BMP10 were significantly associated with recurrence of AF (pooled HR 1.53, 95% CI 1.13–2.07; P = 0.006), with moderate-to-high heterogeneity (I2 = 69%). The association was attenuated and non-significant in the adjusted analysis of two studies with continuous BMP10 (HR 1.46, 95% CI 0.94–2.25; I2 = 59%). However, after the inclusion of a third study with adjusted quartile-based HR, the statistical significance was re-demonstrated (HR 1.33, 95% CI 1.16–1.53; P < 0.001) with low heterogeneity (I2 = 20%). Conclusion: Elevated BMP10 levels are correlated with higher risk of AF recurrence following catheter ablation. Although the results are consistent across analyses, they should be interpreted with caution due to the small number of studies and methodological heterogeneity. BMP10 needs to be confirmed as a clinically applicable biomarker by larger prospective studies.