P178 Sinus rhythm restoration by catheter ablation improved cognitive function in elderly patients with atrial fibrillation

2020 ◽  
Vol 41 (Supplement_1) ◽  
Author(s):  
K Fujiyoshi ◽  
M Minami ◽  
D Saito ◽  
T Hashimoto ◽  
T Yoshizawa ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cognitive Function ◽  
Catheter Ablation ◽  
Elderly Patients ◽  
Sinus Rhythm ◽  
Mmse Score ◽  
Effect Estimate ◽  
Significant Difference ◽  
The Impact ◽  
Af Recurrence

Abstract Background Atrial fibrillation (AF) may cause cognitive impairment. However, the impact of sinus rhythm (SR) restoration by catheter ablation on the improvement of cognitive function remains to be elucidated. Methods A total of 57 consecutive elderly patients (70.8 ± 4.8 years old) who underwent catheter ablation for AF were prospectively enrolled. The change of cognitive function for 6 months was compared between patients with SR restoration (at least 3 months; n = 49) and patients with AF recurrence (n = 8). Cognitive function was evaluated by the mini-mental state examination (MMSE). Results There was no significant difference in baseline characteristics between the 2 groups, including MMSE score (27.3 ± 2.6 vs. 27.6 ± 1.5 points; p = 0.793). The change of MMSE score was significantly greater in patients with SR restoration than those with AF recurrence (0.28 ± 0.70 vs. − 0.50 ± 0.75 points; p = 0.006; Figure). The general liner modeling revealed that SR restoration (effect estimate, 0.369; 95% confidence interval, 0.110 to 0.627; p = 0.006) was independently associated with the change of MMSE score. Conclusion In elderly AF patients, successful restoration of SR by catheter ablation was associated with the improvement of cognitive function. Abstract P178 Figure

scholarly journals Impact of Left Atrial Geometric Remodeling on Late Atrial Fibrillation Recurrence After Catheter Ablation

2021 ◽  
Author(s):  
Fuqian Guo ◽  
Caiying Li ◽  
Lan Yang ◽  
Chen Chen ◽  
Yicheng Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Regression Analysis ◽  
Catheter Ablation ◽  
Left Atrial ◽  
Volume Index ◽  
Multivariable Logistic Regression Analysis ◽  
Significant Difference ◽  
The Impact ◽  
Af Recurrence

Abstract Purpose: To quantitatively investigate the impact of left atrial (LA) geometric remodeling on atrial fibrillation (AF) recurrence after catheter ablation (CA).Methods: A retrospective analysis of 105 patients with AF who underwent coronary computed tomographic angiography before CA. Risk factors for AF recurrence were identified by multivariable logistic regression analysis and used to create a nomogram.Results: After at least 12 months of follow-up, 30 patients (29%) developed recurrent AF. Patients with recurrence had a higher LA volume, LA sphericity, and a lower LA ejection fraction (LAEF) (P < 0.05). There was no significant difference in asymmetry index between the two groups (P = 0.121). Multivariable regression analysis showed that LA minimal volume index (LAVImin) (OR: 1.280, 95% CI: 1.027–1.594, P = 0.028), LA sphericity (OR: 1.268, 95% CI: 1.071–1.500, P = 0.006) and CHA2DS2-VASc score (OR: 1.326, 95% CI: 1.016–1.732, P=0.038) were independent predictors of AF recurrence. The combined model of the LA sphericity to the LAVImin substantially increased the predictive power for AF recurrence (area under the curve [AUC] = 0.736, 95% CI: 0.627–0.844, P < 0.001), with a sensitivity of 80% and a specificity of 61%. A nomogram was generated based on the contribution weights of the risk factors; the AUC was 0.769 (95% CI: 0.666–0.872) and had good internal validity.Conclusion: The CHA2DS2-VASc score, LA sphericity, and LAVImin were significant and independent predictors of AF recurrence after CA. Furthermore, the nomogram had a better predictive capacity for AF recurrence.

Impact of Obesity on Atrial Fibrillation Recurrence Following Stand-Alone Cox Maze IV Procedure

2021 ◽  
pp. 155698452110171
Author(s):  
Robert M. MacGregor ◽  
Ali J. Khiabani ◽  
Nadia H. Bakir ◽  
Meghan O. Kelly ◽  
Samuel C. Perez ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Major Complication ◽  
Obese Patients ◽  
Surgical Ablation ◽  
Significant Difference ◽  
Short And Long Term ◽  
Procedural Outcomes ◽  
The Impact ◽  
Af Recurrence

Objective Obesity is a strong and independent factor for the development of atrial fibrillation (AF), and adversely impacts the success of catheter ablation procedures for AF. This study evaluated the impact of body mass index (BMI) on the outcomes following surgical ablation of AF. Methods Between 2003 and 2019, 236 patients underwent a stand-alone biatrial Cox maze IV procedure (CMP-IV) for refractory AF. Obesity was defined as BMI ≥30 kg/m2. Patients were divided into two groups: BMI <30 kg/m2 ( n = 100) and BMI ≥30 kg/m2 ( n = 136). Freedom from atrial tachyarrhythmia (ATA) was determined using electrocardiography, Holter, or pacemaker interrogation at 1 year and annually thereafter. Recurrence was defined as any documented ATA lasting ≥30 s. Predictors of recurrence were determined using multivariable logistic regression. Preoperative and procedural outcomes were compared between groups. Results Obese patients had a higher rate of diabetes (16% vs 7%, P = 0.044) and larger left atrial diameter (4.9 ± 1.1 cm vs 4.6 ± 1.0 cm, P = 0.021) when compared to non-obese patients. There was no difference in major complication rate between the groups (4% vs 7%, P = 0.389). There was no operative mortality in either group. During 4.1 ± 2.4 years of follow-up, there was no significant difference in freedom from ATA with or without antiarrhythmic drugs in obese patients when compared to the non-obese group ( P > 0.05). Absence of sinus rhythm at discharge predicted AF recurrence up to 7 years postoperatively. Conclusions As opposed to catheter ablation, obesity did not adversely impact the short and long-term outcomes of stand-alone surgical ablation with CMP-IV, and BMI was not a predictor of AF recurrence. Additionally, there was no significant increase in major complications in obese patients.

scholarly journals Cognitive outcomes post-catheter ablation for atrial fibrillation: a systematic review and meta-analysis

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
R Kerley ◽  
H Dolphin ◽  
H Cronin ◽  
R Murphy ◽  
R O"lionaird ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Cognitive Function ◽  
Catheter Ablation ◽  
Sinus Rhythm ◽  
Large Scale ◽  
Meta Analysis ◽  
Cognitive Outcomes ◽  
Neurocognitive Outcomes ◽  
The Impact

Abstract Funding Acknowledgements Type of funding sources: None. Background Atrial fibrillation (AF) is a known risk factor for cognitive impairment and dementia. Recent data suggests that successful restoration of sinus rhythm by catheter ablation improves cognitive outcomes. Purpose: Our aim was to perform a systematic review and meta-analysis of the available data regarding the effectiveness of AF catheter ablation on neurocognitive outcomes. Methods: A comprehensive literature search was performed through December 1, 2020, for all eligible studies comparing neurocognitive outcomes in AF patients with or without AF catheter ablation. Clinical outcomes included rate of dementia, cognitive function by Montreal Cognitive Assessment (MOCA) and Mini-Mental State Examination (MMSE) scores. Additional outcomes included the impact of time in sinus rhythm on neurocognitive outcomes. Results: We identified 11 studies which evaluated the effect of AF catheter ablation on dementia rate, MMSE and MOCA score. Meta-analysis of observational results indicates a decreased risk of dementia (risk ratio 0.51; 95% CI: 0.43 to 0.60; p &lt;0.001) and an improvement in MOCA scores (2.92 points, p &lt; 0.001) but not MMSE scores in patients undergoing AF catheter ablation compared to medical therapy. In addition, the maintenance of sinus rhythm was identified as a significant factor in dementia rate and improvement of MMSE and MOCA scores observed post catheter ablation therapy. Conclusion: AF catheter ablation may reduce the incidence of dementia and improve cognitive function. A large-scale randomized control trial is warranted before recommendations can be made regarding AF ablation and cognitive outcomes. Abstract Figure.

scholarly journals Impact of Sinus Rhythm Maintenance on Major Adverse Cardiac and Cerebrovascular Events after Catheter Ablation of Atrial Fibrillation: Insights from AF Frontier Ablation Registry

2021 ◽  
Author(s):  
Keisuke Usuda ◽  
Takeshi Kato ◽  
Toyonobu Tsuda ◽  
Hayato Tada ◽  
Satoru Niwa ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Sinus Rhythm ◽  
Primary Endpoint ◽  
Cardiovascular Events ◽  
Af Ablation ◽  
Multicenter Cohort ◽  
Cerebrovascular Events ◽  
The Impact ◽  
Sinus Rhythm Maintenance

Introduction: The impact of catheter ablation for atrial fibrillation (AF) on cardiovascular events and mortality is controversial. We investigated the impact of sinus rhythm maintenance on major adverse cardiac and cerebrovascular events after AF ablation from a Japanese multicenter cohort of AF ablation. Methods and Results: We investigated 2737 consecutive patients (25.6% female, mean age 63.4 ± 10.3 years) who underwent a first catheter ablation for AF from the Atrial Fibrillation registry to Follow the long-teRm Outcomes and use of aNTIcoagulants aftER Ablation (AF Frontier Ablation Registry). The primary endpoint was a composite of stroke, transient ischemic attack, cardiovascular events, and all-cause death. During a mean follow-up of 25.2 months, 2070 (75.6%) patients were free from AF after catheter ablation, and the primary composite endpoint occurred in 122 (4.5%) patients. The AF nonrecurrence group had a significantly lower incidence of the primary endpoint (1.7 per 100 person-years) compared with the AF recurrence group (3.2 per 100 person-years; P = 0.001). The multivariate analysis revealed that freedom from AF (hazard ratio 0.57; 95% confidence interval 0.39–0.83; P = 0.003) was independently associated with the incidence of the composite event.¬¬ Conclusion: In the multicenter cohort of AF ablation, sinus rhythm maintenance after catheter ablation was independently associated with lower rates of major adverse cardiac and cerebrovascular events.

scholarly journals Impaired Brain Activity in Patients With Persistent Atrial Fibrillation Assessed by Near-infrared Spectroscopy and Its Changes After Catheter Ablation

2022 ◽  
Author(s):  
Akiomi Yoshihisa ◽  
Soichi Kono ◽  
Takashi Kaneshiro ◽  
Yasuhiro Ichijo ◽  
Tomofumi Misaka ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Infrared Spectroscopy ◽  
Cognitive Function ◽  
Catheter Ablation ◽  
Sinus Rhythm ◽  
Near Infrared Spectroscopy ◽  
Near Infrared ◽  
Brain Activity ◽  
Control Subjects ◽  
Regional Cerebral Blood Volume

Abstract Although the prevalence of cognitive impairment and depression is higher in patients with atrial fibrillation (AF) than in the general population, the mechanism has not been fully examined and impact of catheter ablation (CA) of AF also remains unclear. Recently, the development of near-infrared spectroscopy (NIRS) has enabled noninvasive measurements of regional cerebral blood volume and brain activity, in terms of cerebral oxyhemoglobin in the cerebral cortex. We assessed brain activities by NIRS, depressive symptoms by the Center for Epidemiologic Studies Depression Scale (CES-D) and cognitive function by Mini-Mental State Examination (MMSE). We then compared the results between AF patients (paroxysmal AF n=18 and persistent AF n=14) and control subjects (n=29). Next, we also followed up persistent AF patients who kept sinus rhythm at 3 months after CA (n=8) and measured their brain activities using NIRS, CES-D and MMSE after CA to investigate the associations of changes in brain activities with changes in both CES-D and MMSE. Our results showed that 1) frontal and temporal brain activities were lower in patients with persistent AF than both in control subjects and paroxysmal AF patients (P<0.01), 2) frontal and temporal brain activities were improved in more than half of the persistent AF patients who kept sinus rhythm at 3 months after CA, especially in those who presented impaired brain activity before CA, and 3) improvement of frontal brain activity was associated with improvement of CES-D (R=-0.793, P=0.019), whereas improvement of temporal brain activity was associated with improvement of MMSE (R=0.749, P=0.033). NIRS measurement showed reduced frontal and temporal brain activities in the persistent AF patients, CA improved frontal and temporal brain activities in some of these patients, and associated with improvement of depressive state and/or improvement of cognitive function.

scholarly journals Cognitive Function and Atrial Fibrillation: From the Strength of Relationship to the Dark Side of Prevention. Is There a Contribution from Sinus Rhythm Restoration and Maintenance?

Medicina ◽  
2019 ◽  
Vol 55 (9) ◽  
pp. 587 ◽  
Author(s):  
Emanuele Gallinoro ◽  
Saverio D’Elia ◽  
Dario Prozzo ◽  
Michele Lioncino ◽  
Francesco Natale ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cognitive Function ◽  
Sinus Rhythm ◽  
Cognitive Decline ◽  
Cognitive Dysfunction ◽  
Population Aging ◽  
Cerebral Hypoperfusion ◽  
Dark Side ◽  
White Matter Hyperintensity ◽  
The Impact

Atrial fibrillation (AF) is the most common chronic cardiac arrhythmia with an increasing prevalence over time mainly because of population aging. It is well established that the presence of AF increases the risk of stroke, heart failure, sudden death, and cardiovascular morbidity. In the last two decades several reports have shown an association between AF and cognitive function, ranging from impairment to dementia. Ischemic stroke linked to AF is a well-known risk factor and predictor of cognitive decline. In this clinical scenario, the risk of stroke might be reduced by oral anticoagulation. However, recent data suggest that AF may be a predictor of cognitive impairment and dementia also in the absence of stroke. Cerebral hypoperfusion, reduced brain volume, microbleeds, white matter hyperintensity, neuroinflammation, and genetic factors have been considered as potential mechanisms involved in the pathogenesis of AF-related cognitive dysfunction. However, a cause-effect relationship remains still controversial. Consequently, no therapeutic strategies are available to prevent AF-related cognitive decline in stroke-free patients. This review will analyze the potential mechanisms leading to cognitive dysfunction in AF patients and examine the available data on the impact of a sinus rhythm restoration and maintenance strategy in reducing the risk of cognitive decline.

P6597Long-term impact of catheter ablation on growth differentiation factor-15 and neutrophil-lymphocyte ratio in paroxysmal atrial fibrillation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Bin Waleed ◽  
Y L Xia ◽  
L J Gao ◽  
Y Xiaomeng ◽  
G Tse ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Sinus Rhythm ◽  
Inflammatory Biomarkers ◽  
Growth Differentiation Factor 15 ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Differentiation Factor ◽  
Significant Difference

Abstract Background There is increasing evidence that inflammatory biomarkers growth differentiation factor 15 (GDF-15) and neutrophil-lymphocyte ratio (NLR) appear to be associated with stroke and adverse cardiovascular events in patients with atrial fibrillation (AF). However, long-term impact of catheter ablation (CA) on GDF-15 and NLR is still unknown. Objective To evaluate the long-term change in GDF-15 and NLR after CA in paroxysmal AF patients. Methods A total of 58 paroxysmal AF patients were consecutively enrolled to perform CA. The inflammatory biomarkers GDF-15 and NLR were measured at baseline and 6-months postablation. Results All patients except one could complete 6-Months follow up. Fifty (87.7%) patients maintained sinus rhythm (SR group) and seven (12.3%) patients sustained AF recurrence (AFR group). No significant difference was noted in clinical and procedural characteristics between two groups (p>0.05), except mean fluoroscopy time (minutes 22±11.7 vs. 13±5.3, p=0.001) significantly longer in AFR than SR group. The GDF-15 (pg/ml 195±57 vs. 216±88, p=0.398), and NLR (% 1.8 (1.3–3) vs. 2.6 (1.4–3.4), p=0.395) were comparable at baseline in both SR and AFR groups respectively. At 6-months postablation, GDF-15 (pg/ml 133±41 vs. 195±57, p<0.001), and NLR (% 1.6 (1.1–2) vs. 1.8 (1.3–3), p=0.004) were significant deceased compared to baseline levels in SR group. However, GDF-15 (pg/ml 139±86 vs. 216±88, p=0.064), and NLR (% 1.6 (1.2–3) vs. 2.6 (1.4–3.4), p=0.398) biomarkers remained comparable to baseline level in AFR group (p>0.05) Conclusion Inflammatory biomarkers; GDF-15 and NLR significantly decreased at long-term on successful maintenance of sinus rhythm by CA in paroxysmal AF patients. Acknowledgement/Funding None

Abstract 256: Cardiac CT in Ablation of Atrial Fibrillation

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Ala Mohsen ◽  
Nicole Worden ◽  
Manju Bengaluru Jayanna ◽  
Michael Giudici
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Ct Scan ◽  
Radiation Exposure ◽  
Cardiac Ct ◽  
Pulmonary Veins ◽  
Cryoballoon Ablation ◽  
Atrial Fibrillation Recurrence ◽  
Significant Difference ◽  
The Impact

Background: This study aims to determine the impact of pre-procedural cardiac computerized tomography (CT) on procedural efficacy, clinical outcome and complications in patients who undergo radiofrequency or cryo-therapy catheter ablation to eliminate atrial fibrillation (AF). Methods: In this retrospective review, Radiofrequency or Cryoballoon ablation was done on 50 consecutive patients with atrial fibrillation with mean age of 63 (Min 47-Max 86) with paroxysmal (8 2 %) or persistent (18%) AF. Twenty-five patients underwent cryoablation and twenty-five patients underwent Radiofrequency ablation to isolate the pulmonary veins. Procedural and clinical outcomes were compared among patients who underwent catheter ablation with and without pre procedural Cardiac CT. Results: Out of 50 consecutive patients between 01/2014 and 08/2014 there were 26 patients who had a pre-procedural CT scan and 24 patients who did not undergo a pre-procedural CT scan. The mean duration of the procedure (303 ± 93 vs. 271 ± 43 min, P = 0.244) and fluoroscopy time (53 ± 25 vs. 43 ± 17 min, P = 0.086) was similar among patients who did and did not have pre-procedural cardiac CT. The occurrence of complications such as bleeding, pericardial tamponade, pneumothorax, infection and embolic events were also similar in both groups. Repeat ablation was performed in 4 (15%) and 7 (29%) of the patients who did and did not have cardiac CT, respectively (P = 0.249). At 3 months, 5 (19%) and 2(8%) of the patients who did and did not have pre-procedural cardiac CT had atrial fibrillation recurrence (P =0.323). At 12 months, 6 (23%) and 4 (17%) of the patients who did and did not have pre-procedural cardiac CT had atrial fibrillation recurrence (P = 0.467). There was statistically significant difference in Radiation exposure (1805 [IQR 998-2397] vs. 1195 [IQR 738-1363] P=0.0323) between patients who did and did not get pre-procedural cardiac CT, which did not include the radiation added by performing the CT itself. Conclusions: Pre-procedural structural anatomy obtained by cardiac CT scan before catheter ablation for atrial fibrillation in a center where operators used both Radiofrequency and Cryoablation does not appear to have a significant effect on AF recurrence at 3 months or 1 year. The procedural radiation exposure was significantly less in the group that did not have pre-procedure cardiac CT.

scholarly journals The impact of catheter ablation for patients with asymptomatic atrial fibrillation: subanalysis of kansai plus atrial fibrillation (kpaf) registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Pak ◽  
A Kobori ◽  
S Shizuta ◽  
Y Sasaki ◽  
T Toyota ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Primary Endpoint ◽  
Hazard Analysis ◽  
Secondary Endpoint ◽  
Asymptomatic Patients ◽  
Significant Difference ◽  
Secondary Endpoints ◽  
The Impact

Abstract Background Catheter ablation (CA) of atrial fibrillation (AF) for symptomatic patients improves the quality of life and prognosis of patients with heart failure. However, the impact of CA for asymptomatic patients is still controversial. Purpose We aimed to investigate the clinical outcomes of CA of AF for asymptomatic patients compared to those for symptomatic patients. Methods A total of 5,013 patients from the Kansai Plus Atrial Fibrillation (KPAF) Registry who underwent CA were screened. The patients were divided into three groups by type of AF; paroxysmal (PAF), persistent (PEAF) and long standing (LSAF) and the patients in each type of AF were divided into two groups: asymptomatic and symptomatic. The primary endpoint was recurrent supraventricular tachyarrhythmias lasting for more than 30 seconds during follow-up 4 years after CA. The secondary endpoint was a composite of cardiovascular, cerebral, and gastrointestinal events during follow-up 4 years after CA. The incidence of complications related to CA between asymptomatic and symptomatic patients was also evaluated. Kaplan–Meier analysis was employed to estimate the primary and secondary endpoints. The statistical differences in primary and secondary endpoints between asymptomatic and symptomatic patients were evaluated using a log–rank test. The impact of symptom due to AF on the primary and secondary endpoint was evaluated using a Cox hazard analysis. The difference in incidence of complications between asymptomatic and symptomatic patients was evaluated using a chi–square test. Results In this study population, PAF was the most frequent at 64.4%, followed by PEAF (22.7%) and LSAF (13.0%). There were some significant differences in the baseline characteristics between asymptomatic and symptomatic patients in each type of AF. The proportion of male was significantly higher in asymptomatic patients than symptomatic patients in PAF (81.2% versus 67.2%, p&lt;0.001) and PEAF (86.4% versus 74.3%, p&lt;0.001). Left atrial diameter was larger in asymptomatic patients than symptomatic patients only in PAF (40±6mm versus 38±6mm, p&lt;0.001). In all types of AF, there was no significant difference in primary endpoint between asymptomatic and symptomatic patients as follows: 37.5% versus 40.6% (p=0.6) in PAF, 45.2% versus 55.1% (p=0.09) in PEAF and 59.3% versus 63.6% (p=1.0) in LSAF. There was also no significant difference in secondary endpoint between asymptomatic and symptomatic patients: 7.1% versus 6.8% (p=0.7) in PAF, 5.4% versus 8.7% (p=0.3) in PEAF and 4.4% versus 5.1% (p=0.5) in LSAF. In a Cox hazard analysis, the symptom did not affect both of the primary and secondary endpoints in each type of AF. In regard to the incidence of complications related to CA, there was no significant difference between asymptomatic and symptomatic patients in each type of AF. Conclusion CA of AF for asymptomatic patients can be safe and can lead to equivalent outcomes as well as symptomatic patients. Funding Acknowledgement Type of funding source: None

P980Post-procedural plasma brain natriuretic peptide level early after catheter ablation predicts the future clinical outcome in patients with persistent atrial fibrillation and reduced ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Okada ◽  
K Tanaka ◽  
Y Ninomiya ◽  
Y Hirao ◽  
T Oka ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Clinical Outcome ◽  
Ejection Fraction ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Persistent Atrial Fibrillation ◽  
Cardiovascular Death ◽  
The Impact ◽  
Af Recurrence

Abstract Background Successful restoration of sinus rhythm (SR) by catheter ablation (CA) for persistent atrial fibrillation (AF) improves cardiac function, resulting in decrease of plasma brain natriuretic peptide (BNP) level. The exact significance and prognostic implications of this change have yet to be determined. Purpose To examine the impact of pre- and post-procedural BNP level on the clinical outcome after CA in patients with persistent AF and reduced left ventricular ejection fraction (LVEF). Methods Out of 242 patients with LVEF <50% who underwent first-time CA for persistent AF between March 2012 and September 2018 at our institute, we enrolled 137 patients (61±10 years, 83% male) whose plasma BNP level was available both at baseline and early after CA (during 1–3 month). We evaluated the impact of the BNP levels on future AF recurrence 3 months after CA as the primary endpoint. Additional secondary endpoints included heart failure (HF) hospitalization and cardiovascular death. Results All patients successfully restored SR at the end of CA. Within 3 months of a blanking period (BP), improvement of LVEF (from 39±10% to 65±12%, p<0.001) and reduction of BNP levels (from 178 [107–332] pg/ml to 42.3 [21.1–78.6] pg/ml, p<0.001) were observed. During the median follow-up of 21 months after BP, the incidence of AF recurrence, HF hospitalization, and cardiovascular death was 37% (n=50), 3% (n=4), and 1% (n=1), respectively. Cox proportional hazard regression analysis after adjustment for age and gender revealed that post-procedural BNP level was a significant predictor of the AF recurrence (hazard ratio [HR] per 100-pg/ml increase, 1.13; 95% confidence interval [CI], 1.02–1.25; p=0.023), but pre-procedural BNP level was not (1.02; 0.95–1.09; p=0.56). Receiver operating curve analysis determined the post-procedural BNP level of 55.5 pg/ml as the best cut-off value for predicting the AF recurrence, with area under the curve of 0.620 (95% CI, 0.534–0.702; p=0.018). The incidence of AF recurrence was significantly higher in patients with post-procedural BNP level >55.5 pg/ml (n=50) than the others (50% vs. 29%; HR, 3.99; 95% CI, 2.07–7.68; p<0.001). No patients with post-procedural BNP level ≤55.5 pg/ml experienced HF hospitalization and cardiovascular death (8% vs. 0% and 2% vs. 0%, p=0.006 and p=0.17, respectively) Conclusions Not pre-procedural but post-procedural BNP level early after CA predicted the future clinical outcome in patients with persistent AF and reduced LVEF. Decreased but still elevated BNP level after restoration of SR would identify the residual risk for developing unfavorable outcome.

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