Connective Tissue Growth Factor: A Predictor of Recurrence after Catheter Ablation in Patients with Nonparoxysmal Atrial Fibrillation

Abstract

Although catheter ablation can effectively eliminate atrial fibrillation (AF), the progression of atrial remodeling increases the risk of recurrence. We, therefore, examined the possibility of determining the postablation prognosis of patients with AF using biomarkers of atrial structural remodeling and serum connective tissue growth factor (CTGF) level, and measured its changes after catheter ablation. Subjects were 400 consecutive patients (308 with paroxysmal AF and 92 with nonparoxysmal AF [persistent and long-standing persistent AF]) who underwent catheter ablation for drug-resistant AF. Serum CTGF levels were measured before and 2 months after ablation. During the follow-up period of 20.5 ± 6.9 (8-30) months, 61 patients (66%) with nonparoxysmal AF and 95 patients (31%) with paroxysmal AF had recurrence after catheter ablation. Recurrence was associated with higher "baseline CTGF level" in patients with nonparoxysmal AF (936.5 ± 93.1 ng/mL vs 746.3 ± 56.9 ng/mL, P = 0.007) instead of patients with paroxysmal AF (851.6 ± 97.6 ng/mL vs 807.6 ± 99.1 ng/mL, P = 0.921). In nonparoxysmal AF, the recurrence subgroup also had larger left atrial diameter (LAD; 47.1 ± 5.2 mm vs 39.5 ± 4.3 mm, P = 0.035) compared with the nonrecurrence subgroup, and "baseline serum CTGF" and LAD were shown to be independent predictors for postablation recurrence by a Cox proportional hazards model. However, the 2-month postablation elevations of CTGF in patients with recurrence were not significantly different from that in patients without recurrence in nonparoxysmal AF. Our finding indicates that "baseline serum CTGF level" is an independent predictor for recurrence in patients with nonparoxysmal AF following catheter ablation. Two-month postablation elevation in CTGF has no association with recurrence.