Key result
Circulating biomarkers showed no significant association with AF symptom burden, though 12 markers differed vs controls (NT-proBNP 2.9-fold higher) and 51 changed 1 day post-ablation.
Why the study?
Atrial fibrillation causes debilitating symptoms in some patients while others remain asymptomatic, and the biological basis for this difference remains unclear.
Are circulating inflammatory and cardiac biomarkers associated with symptom burden in patients with symptomatic atrial fibrillation undergoing first-time catheter ablation, and how do these biomarkers differ compared to matched controls and on the first post-procedural day?
Case-Control (n=199)
No
Are circulating inflammatory and cardiac biomarkers associated with symptom burden in patients with symptomatic atrial fibrillation undergoing first-time catheter ablation, and how do these biomarkers differ compared to matched controls and on the first post-procedural day?
In patients with symptomatic AF undergoing catheter ablation, circulating inflammatory and cardiac biomarkers did not correlate with symptom burden after multiple-testing correction, though distinct baseline differences from healthy controls (e.g., NT-proBNP, CCL20, CXCL10) and marked day-1 post-ablation inflammatory and myocardial injury responses were identified.
AF symptom burden should not be inferred from these biomarkers; leaves open their diagnostic and post-ablation monitoring roles.
Atrial fibrillation (AF) causes debilitating symptoms in some patients, whereas others remain asymptomatic; the biological basis remains unclear. In this prospective case–control study, we investigated whether circulating biomarkers were associated with symptom burden, differed between patients with symptomatic AF and controls, and differed between samples collected before catheter ablation and on the first post-procedural day. We enrolled 100 patients undergoing first-time AF ablation and 100 age- and sex-matched controls; one patient with AF was excluded because of compromised blood samples. Symptoms were assessed using the AF6 questionnaire and EHRA score. Ninety-two proteins were measured using the Olink Target 96 Inflammation panel, and six additional biomarkers were analysed locally. The median AF6 was 23 (IQR 14–32), and 46% had modified EHRA score III. No statistically significant biomarker–symptom associations were detected after Bonferroni correction. In age- and sex-adjusted comparisons, 12 biomarkers differed between patients with AF and controls, including higher NT-proBNP, CCL20, and CXCL10, and lower FGF-19. On the first post-procedural day, 51 biomarkers differed significantly from pre-procedural levels, with the largest increases observed for hs-TnI, IL-6, and hs-CRP. These findings demonstrate biomarker differences between AF patients and controls and an acute post-procedural response consistent with myocardial injury and inflammation. Clinical trial registration: ClinicalTrials.gov NCT05201989 09/01/2022.
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Jackson et al. (2026) conducted a case-control in Symptomatic atrial fibrillation (n=199). Circulating inflammatory and cardiac biomarkers in symptomatic atrial fibrillation and catheter ablation vs. Age- and sex-matched controls without atrial fibrillation (and pre-ablation vs 1 day post-ablation) was evaluated on Association between pre-procedural circulating biomarker levels (92 Olink inflammation proteins and 6 local biomarkers) and AF symptom burden (AF6 sum score) (p=NS after Bonferroni correction). Circulating biomarkers showed no significant association with AF symptom burden, though 12 markers differed vs controls (NT-proBNP 2.9-fold higher) and 51 changed 1 day post-ablation.
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