AIMS:
Pre-procedural identification of patients with atrial fibrillation (AF) who will remain free from AF after pulmonary vein isolation (PVI) remains challenging. Clinical risk scores, including CHADS2, CHA2DS2-VASc, R2CHADS2, and HATCH scores show modest discriminative ability with respect to AF recurrence. B-type natriuretic peptide (BNP) is associated with risk for AF and AF recurrence but is not currently included in existing AF risk scores. We sought to evaluate the incremental benefit of adding pre-operative BNP to existing risk scores in predicting AF recurrence within 6-months after PVI.
METHODS AND RESULTS:
One hundred and fifty one patients (105 men, age 60 ± 10 years) with paroxysmal or persistent AF underwent an index PVI procedure between 2010-2014. Seventy-seven patients had an AF recurrence (51%) over the 6-month follow-up period. BNP level of >100 units was significantly associated with 6-month AF recurrence in univariate models (p<0.001). A composite risk score including BNP to the existing scores significantly improved their predictive value and net AF recurrence reclassification (net reclassification index, 63.4%; p<0.001) (Table 1).
CONCLUSIONS:
Addition of BNP to existing AF risk scores enhanced their predictive value and discriminative ability in predicting AF recurrence after PVI. Further research is needed including large and diverse cohorts of patients undergoing ablation and monitored for AF recurrence over extended periods to further validate the performance of this composite score.
Persistent atrial fibrillation presenting in sinus rhythm: Pulmonary vein isolation versus pulmonary vein isolation plus electrogram-guided ablation
