Background
Freedom of clinical recurrence of atrial fibrillation (AF) within one year after ablation is target for successful outcome. Biomarker level prior ablation may help to identify patients at risk for AF recurrence.
Purpose
We investigated association of AF recurrence within one year after AF ablation by cardiovascular biomarker.
Methods
Clinical recurrence of AF was investigated in 226 subjects of the AFAB registry (Maastricht, the Netherlands) after AF ablation. Blood samples prior ablation procedure were analyzed for known and novel cardiovascular biomarkers (FGF23, BMP10, Ang2, IGFBP7, CA125, NT-proBNP, TNT_hs, sFlt_1, ESM1_7F89A5, DKK3). After a blanking period of 3 months, recurrence of AF was defined as symptomatic or ECG documented episode. All patients were followed-up 12-months after ablation including a Holter-ECG. Biomarker levels were compared between clinical recurrence of AF to those without by independent T-test (two-sided). A logistic regression model adjusted for typical risk factors of AF recurrence (Sex, age, type of AF (paroxysmal or persistent), heart failure, body mass index and hypertension) was calculated and receiver-operating analysis was performed for prediction of AF recurrence.
Results
We found significant elevated biomarker level in patients with AF recurrence for BMP10, Ang2, and NT-proBNP (table1). In the logistic regression Ang2 (OR 1.315 95%CI 1.034-1.672, P=0.025) and - although not significant - BMP10 (OR 2.064 95%CI 0.885-4.729, P=0.057) indicated a high probability of AF recurrence within one year (Figure 1). By a model including factors of AF recurrence predictability for AF recurrence had an AUC of 0.66 (sensitivity 67%, specificity 56%). By adding Ang2 predictability increases further to AUC of 0.68 (sensitivity 70%, specificity 58%).
Conclusions
Based on our data, patients with recurrence of AF within one year after ablation had elevated levels for BMP10, Ang2, and NT-proBNP prior AF ablation. Ang2 and BMP10 outperformed the other investigated known and novel biomarker indicating a higher probability of AF recurrence within one year after ablation.
Table 1 Preprocedural cardiovascular biomarker levels in patients with and without AF recurrence one year after AF ablation
|
n= |
No AF recurrence (n=137) |
AF recurrence (n=89) |
P= | |
|
FGF23 |
226 |
143.2±180.8 |
143.7±973.2 |
0.980 |
|
BMP10 |
226 |
1.809±0.383 |
1.923±0.376 |
0.028 |
|
Ang2 |
226 |
2.191±0.973 |
2.746±1.76 |
0.008 |
|
IGFBP7 |
226 |
74.2±14.53 |
76.06±11.97 |
0.295 |
|
FABP3 |
226 |
35.43±17.73 |
34.89±13.17 |
0.791 |
|
CA125 |
225 |
12.34±66.01 |
12.94±80.07 |
0.560 |
|
NT_proBNP |
226 |
368.9±449.9 |
586.8±621 |
0.005 |
|
TNT_hs |
221 |
12.12±16.92 |
15.04±23.41 |
0.314 |
|
sFlt_1 |
225 |
632.7±1157 |
784.7±1330 |
0.379 |
|
ESM1_7F8_9A5 |
224 |
2.389±1.12 |
2.437±1.168 |
0.759 |
|
DKK3 |
226 |
52.03±12.95 |
54.18±12.1 |
0.206 |
Figure 1 Odd's ratio of biomarker for AF recurrence within 12 months after ablation. Logistic regression model was adjusted for sex, age, type of AF (paroxysmal or persistent), heart failure, body mass index and hypertension
Figure 1 Odd's ratio of biomarker for AF recurrence within 12 months after ablation. Logistic regression model was adjusted for sex, age, type of AF (paroxysmal or persistent), heart failure, body mass index and hypertension
https://dgk.org/kongress_programme/jt2022/aP481.html