scholarly journals Relationship between natriuretic peptides and left atrial mechanics and their relation to recurrence of atrial fibrillation following catheter ablation

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
FJ Olsen ◽  
S Darkner ◽  
JP Goetze ◽  
X Chen ◽  
K Henningsen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Atrial Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Natriuretic Peptides ◽  
Left Atrial ◽  
Increased Risk ◽  
Atrial Strain ◽  
Af Recurrence ◽  
Atrial Natriuretic

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation (grant no.: 09-04-R72-A2408-22545, 10-04-R78-A2929-22588, 11-04-R84-A3230-22650, and 18-R125-A8534-22083), and the Heart Centre Research Committee at Rigshospitalet, Copenhagen. Background The relationship between natriuretic peptides and atrial distension is not completely understood. Furthermore, how they can be used together clinically has not been fully explored. Purpose We sought to examine their interrelationship and how they relate to atrial fibrillation (AF) recurrence following catheter ablation. Methods Patients scheduled for catheter ablation as part of a randomized controlled clinical trial were included. Patients who underwent pre-operative echocardiography and had natriuretic peptide measurements performed, specifically mid-regional proANP (MR-proANP) and N-terminal proBNP (NT-proBNP), were included in this analysis. Echocardiography included assessment of atrial distension by left atrial strain. The outcome was AF recurrence at 6 months after a 3-month blanking period. Logistic regression was performed to assess the association between log-transformed natriuretic peptides and AF. Multivariable adjustments were made for age, gender, randomization, and LVEF. Results Out of 99 patients 44 developed AF. No differences in natriuretic peptides nor echocardiographic measures were observed between the outcome groups. Neither MR-proANP nor NT-proBNP were univariable predictors of AF recurrence (MR-proANP: OR = 1.06 (0.99-1.14), p = 0.09, per 10% increase; NT-proBNP: OR = 1.01 (0.98-1.05), p = 0.38, per 10% increase). These findings were unchanged after multivariable adjustments. However, atrial strain significantly modified the association between MR-proANP and AF (p for interaction = 0.009) such that MR-proANP was a significant predictor of AF in patients with high atrial strain values (OR = 1.24 (1.06-1.46), p = 0.008, per 10% increase) but not in patients with low atrial strain values. Among patients with high atrial strain values, an MR-proANP > 116pmol/L was associated with a 10-fold increased risk of AF (OR = 9.78 (2.21-43.33), p = 0.003). figure. Conclusion Atrial natriuretic peptide predicts AF recurrence in patients with preserved atrial distension. Assessing atrial distension by echocardiography may assist the clinical interpretation of atrial natriuretic peptide concentration. Abstract Figure.

scholarly journals Left atrial stiffness measured by echocardiography is a stronger predictor of atrial fibrillation recurrence after radiofrequency catheter ablation than left atrial volume

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
J.M Farinha ◽  
M Fonseca ◽  
L Parreira ◽  
A.F Esteves ◽  
A Pinheiro ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrial ◽  
Radiofrequency Catheter Ablation ◽  
Left Atrial Volume ◽  
Atrial Volume ◽  
Increased Risk ◽  
Unit Increase ◽  
Left Atrial Stiffness ◽  
Af Recurrence

Abstract Introduction Left atrial volume (LAV) is an accepted predictor of atrial fibrillation (AF) recurrence after radiofrequency catheter ablation, stronger than AF duration. Objective The aim of this study was to assess the value of left atrial stiffness (LAS) index as a new parameter evaluated by echocardiography to the prediction of AF recurrence after radiofrequency catheter ablation. Methods We retrospectively studied consecutive patients with paroxysmal or persistent AF submitted to radiofrequency catheter ablation at our institution between 2017 and 2019. We used transthoracic echocardiography to measure the LAV indexed to body surface area and the LAS index, defined as the ratio between the mitral E/e' (obtained with pulsed Doppler at the tip of the mitral leaflets – E, and tissue Doppler imaging at the mitral annulus – e') and the left atrial strain during the reservoir phase (obtained by speckle tracking echocardiography) [LAS index = (E/e') / LA reservoir strain]. The left ventricular ejection fraction (LVEF) was also evaluated. Patients with poor quality echocardiographic images were excluded. We compared 2 groups of patients, according to the recurrence of AF after the blanking period. We analysed the clinical characteristics and echocardiographic findings. The effect of clinical and echocardiography parameters on AF recurrence was evaluated by univariate and multivariate Cox Regression analysis. Results We studied 33 patients, 27 with paroxysmal AF and 6 with persistent AF. Baseline patients' characteristics are presented in Table 1. During a mean follow-up time of 17.9±10.4 months, 7 patients (21%) had AF recurrence, and none died. Patients with AF recurrence had a higher LAS index. After adjusting for confounding variables, only LAS index and LAV were independently associated with AF recurrence (Table 2). Every one unit increase in LAS index was associated with an 11-fold increased risk of AF recurrence (HR 10.86, 95% CI 1.38–85.56; p=0.024), while every one unit increase in LAV index was only associated with a 6% increased risk of AF recurrence (HR 1.06, 95% CI 1.01–1.11, p=0.010). Conclusion LAS index evaluated by echocardiography was a much stronger predictor of AF recurrence after radiofrequency catheter ablation than left atrial volume. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Posterior Left Atrial Adipose Tissue Attenuation Assessed by Computed Tomography and Recurrence of Atrial Fibrillation after Catheter Ablation

2021 ◽  
Author(s):  
Mohammed El Mahdiui ◽  
Judit Simon ◽  
Jeff M. Smit ◽  
Jurrien H. Kuneman ◽  
Alexander R. van Rosendael ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Adipose Tissue ◽  
Catheter Ablation ◽  
Left Atrial ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Imaging Biomarker ◽  
Rank Test ◽  
Increased Risk ◽  
Af Recurrence

Background - Atrial fibrillation (AF) recurrence following catheter ablation remains high. Recent studies have shown a relation between epicardial adipose tissue (EAT) and AF. EAT secretes several pro- and anti-inflammatory adipokines that directly interact with the adjacent myocardium. The aim of the current study was to evaluate whether posterior left atrial (LA) adipose tissue attenuation, as marker of inflammation, is related to AF recurrences after catheter ablation. Methods - Consecutive patients with symptomatic AF referred for first AF catheter ablation who underwent CT were included. The total EAT and posterior LA adipose tissue were manually traced and adipose tissue was automatically recognized as tissue with Hounsfield units (HU) between -195 and -45. The attenuation value of the posterior LA adipose tissue was assessed and the population divided according to the mean HU value (-96.4 HU). Results - In total, 460 patients (66% male, age 61 ± 10 years) were included in the analysis. After a median follow-up of 18 months (IQR 6-32), 168 (37%) patients had AF recurrence. Patients with higher attenuation (≥-96.4 HU) of the posterior LA adipose tissue showed higher AF recurrence rates compared to patients with lower attenuation (<-96.4 HU) (log-rank test p=0.046). Univariate analysis showed an association between AF recurrence and higher posterior LA adipose tissue attenuation (≥-96.4 HU) (p<0.05). On multivariable analysis posterior LA adipose tissue attenuation (HR 1.26; 95% CI 0.90-1.76; p=0.181) remained a promising predictor of AF recurrence following catheter ablation. Conclusions - Posterior LA adipose tissue attenuation is a promising predictor of AF recurrence in patients who undergo catheter ablation. Higher adipose tissue attenuation might signal increased local inflammation and serve as an imaging biomarker of increased risk of AF recurrence.

Atrial natriuretic peptide and left atrial dimension in patients with atrial fibrillation

1998 ◽  
Vol 4 (3) ◽  
pp. 93
Author(s):  
Mihoko Igarashi ◽  
Yutaka Shiina ◽  
Osamu Iwata ◽  
Toru Nakajima ◽  
Jae/Yong Kim ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Left Atrial ◽  
Atrial Natriuretic

scholarly journals Impact of Midregional N‐Terminal Pro–Atrial Natriuretic Peptide and Soluble Suppression of Tumorigenicity 2 Levels on Heart Rhythm in Patients Treated With Catheter Ablation for Atrial Fibrillation: The Biorhythm Study

2021 ◽  
Author(s):  
Marc Badoz ◽  
Guillaume Serzian ◽  
Baptiste Favoulet ◽  
Jean‐Marc Sellal ◽  
Christian De Chillou ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Atrial Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Characteristic Curve ◽  
Venous Blood ◽  
Peripheral Venous Blood ◽  
Risk Of Recurrence ◽  
The Impact ◽  
Atrial Natriuretic

Background We assessed the impact of preprocedural plasma levels of MRproANP (midregional N‐terminal pro–atrial natriuretic peptide) and sST2 (soluble suppression of tumorigenicity 2) on recurrence of atrial fibrillation (AF) at 1 year after catheter ablation of AF. Methods and Results This was a prospective, multicenter, observational study including patients undergoing catheter ablation of AF. MRproANP and sST2 were measured in a peripheral venous blood preprocedure, and MRproANP was assessed in the right and left atrial blood during ablation. The primary end point was recurrent AF between 3 and 12 months postablation, defined as a documented (>30 seconds) episode of AF, flutter, or atrial tachycardia. We included 106 patients from December 2017 to March 2019; 105 had complete follow‐up, and the mean age was 63 years with 74.2% males. Overall, 34 patients (32.1%) had recurrent AF. In peripheral venous blood, MRproANP was significantly higher in patients with recurrent AF (median, 192.2; [quartile 1–quartile 3, 155.9–263.9] versus 97.1 [60.9–150.7] pmol/L; P <0.0001), as was sST2 (median, 30.3 [quartile 1–quartile 3, 23.3–39.3] versus 23.4 [95% CI, 17.4–33.0] ng/mL; P =0.0033). In the atria, MRproANP was significantly higher than in peripheral blood and was higher during AF than during sinus rhythm. Receiver operating characteristic curve analysis identified a threshold of MRproANP>107.9 pmol/L to predict AF recurrence at 1 year and a threshold of >26.7 ng/mL for sST2. By multivariate analysis, MRproANP>107.9 pmol/L was the only independent predictor of recurrent AF (OR, 24.27; 95% CI, 4.23–139.18). MRproANP<107.9 pmol/L identified subjects at very low risk of recurrence (negative predictive value >95%). Conclusions Elevated MRproANP level independently predicts recurrent AF, whereas sST2 levels do not appear to have any prognostic value in assessing the risk of recurrence of AF up to 1 year after catheter ablation. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03351816.

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