scholarly journals Predictive Role of BNP/NT-proBNP in Non-Heart Failure Patients Undergoing Catheter Ablation for Atrial Fibrillation: An Updated Systematic Review

2020 ◽  
Vol 27 (27) ◽  
pp. 4469-4478 ◽  
Author(s):  
Nikolaos Papageorgiou ◽  
Rui Providência ◽  
Debbie Falconer ◽  
Tanakal Wongwarawipat ◽  
Dimitris Tousoulis ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Significant Proportion ◽  
Pharmacological Therapy ◽  
Successful Outcome ◽  
Public Health Issue ◽  
Brain Natriuretic Peptides ◽  
Af Recurrence

: Atrial Fibrillation (AF) is a growing public health issue, associated with significant morbidity and mortality. In addition to pharmacological therapy, catheter ablation is an effective strategy in restoring and maintaining sinus rhythm. However, ablation is not without risk, and AF recurs in a significant proportion of patients. Non-invasive, easily accessible markers or indices that could stratify patients depending on the likelihood of a successful outcome following ablation would allow us to select the most appropriate patients for the procedure, reducing the AF recurrence rate and exposure to potentially life-threatening risks. : There has been much attention paid to Brain Natriuretic Peptide (BNP) and N-Terminal prohormone of Brain Natriuretic Peptide (NT-proBNP) as possible predictive markers of successful ablation. Several studies have demonstrated an association between higher pre-ablation levels of these peptides, and a greater likelihood of AF recurrence. Therefore, there may be a role for measuring brain natriuretic peptides levels when selecting patients for catheter ablation.

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.

scholarly journals Biomarkers of Atrial Fibrillation: Which One Is a True Marker?

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Pipin Ardhianto ◽  
Yoga Yuniadi
Keyword(s):  
Atrial Fibrillation ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Troponin I ◽  
Coronary Artery Stenosis ◽  
Troponin T ◽  
Troponin Elevation ◽  
Brain Natriuretic Peptides ◽  
Prognostic Stratification ◽  
Future Events

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmias and associated with the risk of stroke and death. Continuous development of the diagnostic tool and prognostic stratification may lead to optimal management of AF. The use of biomarkers in the management of AF has been grown as an interesting topic. However, the AF biomarkers are not yet well established in the major guidelines. Among these biomarkers, a lot of data show troponin and brain natriuretic peptides are promising for the prediction of future events. The troponin elevation in AF patients may not necessarily be diagnosed as myocardial infarction or significant coronary artery stenosis, and brain natriuretic peptide elevation may not necessarily confirm heart failure. Troponin T and troponin I may predict postoperative AF. Furthermore, troponin and brain natriuretic peptide gave better prognostic performance when compared with the risk score available today.

The prospect for Catheter Ablation to Atrial Fibrillation by Plasma Brain Natriuretic Peptide

2011 ◽  
Vol 17 (9) ◽  
pp. S156-S157
Author(s):  
Akira Sato ◽  
Junichi Nitta ◽  
Miki Kanou ◽  
Shinsuke Iwai ◽  
Osamu Inaba ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Plasma Brain Natriuretic Peptide

P1030Elevated baseline brain natriuretic peptide level was associated with poor outcome after multiple catheter ablation for paroxysmal atrial fibrillation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Kitagaki ◽  
T Oka ◽  
K Inoue ◽  
K Tanaka ◽  
Y Ninomiya ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Paroxysmal Atrial Fibrillation ◽  
Roc Analysis ◽  
Left Ventricular ◽  
Free Survival ◽  
The Impact

Abstract Background Serum Brain Natriuretic Peptide (BNP) level is associated with various cardiovascular events. Because elevated BNP level reflects increased left ventricular end-diastolic pressure and LA pressure promoting left atrial (LA) remodeling, BNP level might be associated with the extent of arrhythmogenic substrate in patients with atrial fibrillation (AF). We hypothesized that elevated BNP level has impact on outcome after catheter ablation (CA) for AF. Purpose We investigated the impact of baseline BNP level on outcome after multiple CA for paroxysmal atrial fibrillation (PAF), and assessed the association between baseline BNP level and extent of LA remodeling. Methods This was a retrospective, single-center observational study. A total of 287 patients who underwent CA for PAF in our institute from March 2012 to March 2014. All patients had dataset of baseline BNP level and LA volume measured by multi-detector computed tomography (MDCT) in sinus rhythm. First we performed receiver operating characteristic (ROC) analysis for recurrence after multiple CA and obtained the best cut-off value of BNP. Patients were divided into Low BNP and High BNP group based on BNP cut-off value, and AF-free survival was analyzed with log-rank test. To assess the impact of BNP level on recurrence, multivariate Cox regression model were performed. Finally, we assessed the extent of baseline LA remodeling in low BNP and high BNP group. Results During follow-up period, AF recurred in 65/287 patients (26.2%) after multiple CA procedure (follow up 3.4 [2.2, 4.0] years, total number of sessions: 1.39±0.63). Patients with recurrence had greater baseline BNP than those without recurrence (99.8 pg/mL [30.0, 128] vs. 60.7 pg/mL [17.3, 80.8], recurrence vs. no-recurrence, P<0.05). In ROC analysis, baseline BNP had mild accuracy for the prediction of recurrence (AUC: 0.63, P=0.002, best cut-off value: 57.3 pg/mL). We divided patients into High BNP group (BNP≥57.3, N=106) and Low BNP group (BNP<57.3, N=181). AF-free survival was higher in Low BNP than in High BNP (Figure 1) (83.4% vs. 67.0%, Low vs. High, P<0.001). After adjustment with age, gender, hypertension, heart failure, body mass index, LA diameter and LV ejection fraction, High BNP (BNP≥57.3) was associated with recurrence (Hazard ratio: 2.31, 95% CI 1.42–3.75, P<0.001). In baseline parameters of LA remodeling measured with MDCT, Low BNP group had higher LA emptying fraction (41.7±9.5 vs. 32.0±8.5%, Low vs. High, P<0.001) and lower indexed maximum LA volume (48.5±12.0 vs. 61.3±16.7 mL/m2, P<0.001) (Figure 2). Conclusion Baseline serum BNP level was associated with recurrence after multiple procedures for PAF. The baseline extent of LA remodeling was greater in High BNP than in Low BNP. Elevated BNP level might reflect the severe LA remodeling causing ablation-refractory AF even after multiple CA. The preoperative assessment of BNP might be helpful for prediction of multiple CA outcome.

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