Background
Early recurrence of atrial fibrillation (AF) within 3 months after ablation happens to one third of patients. Although, early AF recurrence is not considered for redo procedures and resolves by itself in many cases, it is found to be an independent risk factor for late recurrence of AF. Biomarker level prior ablation may help to identify patients at risk.
Purpose
We investigated association of early AF recurrence within three months after AF ablation by cardiovascular biomarker.
Methods
In 239 subjects of the AFAB registry (Maastricht, the Netherlands) blood samples prior scheduled AF ablation procedure were analyzed for known and novel cardiovascular biomarkers (FGF23, BMP10, Ang2, IGFBP7, CA125, NT-proBNP, TNT_hs, sFlt_1, ESM1_7F89A5, DKK3). Recurrence of AF was defined as symptomatic or ECG documented episode. All patients were followed-up 3-months after ablation including a Holter-ECG. Biomarker levels were analyzed with independent T-test (two-sided). We calculated a model for AF recurrence with a logistic regression analysis adjusted for typical risk factors of AF recurrence (Sex, age, type of AF (paroxysmal or persistent), heart failure, body mass index and hypertension). Prediction was analyzed by a receiver-operating analysis.
Results
We found significant elevated biomarker levels in patients with early AF recurrence (table1) for BMP10, Ang2, and NT-proBNP. In the logistic regression BMP10 (HR 2.559 95%CI 1.089-5.998, P=0.031) indicated a high probability of AF recurrence (figure1). A model including factors of AF recurrence had a predictability of AUC 0.63 (sensitivity 64%, specificity 61%). Adding BMP10 to the model of known risk factors for AF recurrence results in an AUC of 0.66 (sensitivity 67%, specificity 52%).
Conclusions
Based on our data, BMP10, Ang2 and NT-proBNP showed elevated values prior AF ablation for patients with early recurrence of AF. BMP10, which is likely associated with trabeculation of the heart, outperformed the other investigated known and novel biomarker indicating a higher probability of early AF recurrence after ablation.
Table 1 Preprocedural cardiovascular biomarker level according to early AF recurrence within 3 months after ablation
|
n= |
No AF recurrence (n=172) |
AF recurrence (n=67) |
P= |
|
|
FGF23 |
239 |
143.7±169.2 |
138.6±841.4 |
0.759 |
|
239 |
1.832±0.364 |
1.959±0.419 |
0.032 |
|
|
Ang2 |
239 |
2.289±1.103 |
2.806±1.885 |
0.038 |
|
IGFBP7 |
239 |
74.51±14.56 |
77.66±11.85 |
0.086 |
|
FABP3 |
239 |
36.07±17.84 |
34.26±10.46 |
0.332 |
|
CA125 |
238 |
12.89±76.3 |
12.18±59.81 |
0.449 |
|
NT_proBNP |
239 |
411.5±529.4 |
601.2±585.5 |
0.023 |
|
TNT_hs |
234 |
14.1±22.33 |
11.22±74.03 |
0.142 |
|
sFlt_1 |
238 |
611.2±1113 |
908.7±1494 |
0.143 |
|
ESM1_7F8_9A5 |
237 |
2.406±1.198 |
2.406±0.929 |
0.996 |
|
DKK3 |
239 |
52.1±12.2 |
55.56±13.56 |
0.072 |
Figure 1 Odd's ratio for early AF recurrence, logistic regression model adjusted for sex, age, type of AF (paroxysmal or persistent), heart failure, body mass index and hypertension
https://dgk.org/kongress_programme/jt2022/aV1277.html