AI Article Synopsis
- This study investigates how changes in brain natriuretic peptide (BNP) levels before and after catheter ablation for atrial fibrillation (AF) affect patient outcomes, specifically in those also dealing with heart failure (HF).
- In the analysis of 162 patients, those with AF at baseline showed a significant decrease in BNP levels post-ablation, while those in sinus rhythm saw an increase, with poor BNP reduction being linked to worse long-term outcomes like HF hospitalization and increased mortality.
- The findings suggest that monitoring BNP levels can help identify high-risk patients after sinus rhythm is restored, even though the recurrence rates of AF were similar among different BNP response groups.
Article Abstract
Background: Brain natriuretic peptide (BNP) predicts the prognosis in patients with atrial fibrillation (AF) and heart failure (HF); however, the level of BNP can change immediately after restoration of sinus rhythm. We aimed to investigate the clinical impact of serial change in BNP level before and after catheter ablation for AF, on the prognosis.
Methods: In this retrospective single center study, 162 consecutive patients (67±9 years, 66.7% male) with AF and concomitant HF who underwent catheter ablation were examined. We analyzed the cardiac rhythm and % change in BNP pre- and post-ablation.
Results: BNP increased by 32.7% (-4.5% to 51.3%) in patients with sinus rhythm at baseline (sinus rhythm group: N=50) and decreased by 47.6% (20.9 to 61.6%) in patients with AF rhythm at baseline. Patients with AF rhythm at baseline were categorized into two groups according to the median value of reduction in % BNP; patients with good % BNP reduction (good BNP-R group; N=56), and with poor % BNP reduction (poor BNP-R group; N=56). Although the rate of recurrence of AF after ablation was comparable between the good and poor BNP-R groups, poor BNP-R was an independent predictor of subsequent composite events including HF hospitalization, ischemic stroke, and all cause of death after ablation, even after adjusting for other confounders (hazard ratio: 6.85, 95% confidence interval: 2.16 to 21.7, p-value=0.001). In the longitudinal analysis of echocardiographic parameters, shortening of the left ventricular end-diastolic diameter with preserved ejection fraction was evident except in the poor BNP-R group.
Conclusion: In patients with AF and HF, poor % BNP reduction was an independent predictor of adverse outcome, although the rate of recurrence of AF was comparable. Serial BNP measurement might help in better identification of high-risk patients in whom sinus rhythm is restored with catheter ablation.
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| http://dx.doi.org/10.1016/j.jjcc.2020.11.011 | DOI Listing |
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