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March 9, 2026Circulation Reports0 citationsOpen Access

Impaired Atrial Natriuretic Peptide Secretion as a Marker of Advanced Atrial Fibrillation

SOSatoshi OkaKMKoji MiyamotoCAChisa Asahina

Key Result

An ANP/BNP ratio ≤0.7 was associated with an 85% increased risk of atrial arrhythmia recurrence following initial catheter ablation for persistent atrial fibrillation (HR 1.85).

Key Points

  • To investigate the role of atrial natriuretic peptide levels as a marker for advanced atrial fibrillation and its implications for recurrence after catheter ablation.
  • Assessment of atrial natriuretic peptide and B-type natriuretic peptide levels preoperatively.
  • Identification of low-voltage zones in patients with atrial fibrillation.
  • Evaluation of atrial arrhythmia recurrence post-catheter ablation.
  • Low plasma ANP levels correlate with advanced atrial fibrillation stages.
  • Patients with low ANP showed higher recurrence rates of atrial arrhythmia after treatment.
  • Impaired ANP secretion may reflect atrial remodeling and associated low-voltage zones.

Study Design

Type

Cohort (n=166)

Multicenter

No

Structured PICO

Does a preprocedural ANP/BNP ratio ≤0.7 predict left atrial low-voltage zones and atrial arrhythmia recurrence in patients undergoing catheter ablation for persistent atrial fibrillation?

P
Population
166 patients with persistent atrial fibrillation undergoing initial catheter ablation, followed for a median of 583 days.
E
Exposure
Preprocedural serum ANP/BNP ratio ≤0.7 (defined as atrial fatigue) prior to catheter ablation
C
Comparator
Preprocedural serum ANP/BNP ratio >0.7 (control group) prior to catheter ablation
O
Outcome
Diagnostic performance of ANP/BNP ratio for predicting left atrial low-voltage zone (LVZ) presence and any atrial arrhythmia (AA) recurrences within 3 years after catheter ablation lasting ≥30 s beyond the 90-day blanking periodsurrogate

A preprocedural ANP/BNP ratio ≤0.7 serves as a useful biomarker to predict advanced atrial remodeling (LVZs) and a higher risk of atrial arrhythmia recurrence after catheter ablation in patients with persistent AF.

Main Result

Hazard Ratio: 1.85 (95% CI 1.09–3.14)

Absolute Event Rate: 47% vs 29%

p-value: p=0.025

Limitations

  • Single-center retrospective study with a small sample size
  • Different multipolar catheters were used to obtain left atrial high-density bipolar voltage maps
  • Radiofrequency energy was used; results may differ with other energy sources like pulsed-field ablation
  • ANP/BNP ratio can be influenced by several factors such as obesity, left ventricular hypertrophy, or pulmonary hypertension
  • Included only patients with persistent AF, limiting generalizability to paroxysmal AF

Abstract

Background: Significant atrial low-voltage zones (LVZs), indicative of advanced atrial fibrillation (AF), are associated with atrial arrhythmia (AA) recurrence following catheter ablation. Although preoperative prediction remains challenging, a low plasma atrial natriuretic peptide (ANP) level relative to B-type natriuretic peptide (BNP) reflects atrial fatigue with impaired ANP secretion and may indicate advanced atrial remodeling and LVZs.

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Cite This Study

Oka et al. (2026) conducted a cohort in Persistent atrial fibrillation (n=166). ANP/BNP ratio ≤0.7 vs. ANP/BNP ratio >0.7 was evaluated on Atrial arrhythmia recurrence (HR 1.85, 95% CI 1.09-3.14, p=0.025). An ANP/BNP ratio ≤0.7 was associated with an 85% increased risk of atrial arrhythmia recurrence following initial catheter ablation for persistent atrial fibrillation (HR 1.85).

synapsesocial.com/papers/69af23813eac3accde8a1767https://doi.org/10.1253/circrep.cr-25-0340
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