PO-638-04 LOW ATRIAL NATRIURETIC PEPTIDE TO BRAIN NATRIURETIC PEPTIDE RATIO WAS ASSOCIATED WITH LEFT ATRIAL REMODELING AND HOSPITALIZATION DUE TO HEART FAILURE IN PATIENTS WITH ATRIAL FIBRILLATION ABLATION

Abstract

Deficiency of atrial natriuretic peptide (ANP) is thought to contribute to hemodynamic deterioration in case with advanced atrial remodeling due to atrial fibrillation (AF). However, little is known about the association between plasma ANP level and severity of left atrial remodeling or prognosis of heart failure in patients with AF. The purpose of this study was to investigate the association between ANP and left atrial remodeling or prognosis of heart failure in patients with AF ablation. Three hundred and seventy-three consecutive patients who underwent initial ablation for persistent AF (age, 67 ± 10 years; and females, 97 [26%]) were retrospectively enrolled. Plasma ANP and brain natriuretic peptide (BNP) concentration were measured before the procedure and ANP/BNP ratio was calculated. Left atrial appendage emptying velocity (LAAEV), left atrial low voltage areas (LVAs), and left atrial volume index (LAVI) were used as clinical factors of left atrial remodeling. Median plasma ANP level was 116 (71-178) pg/ml, and median ANP/BNP ratio was 0.65 (0.46-1.00). Plasma ANP levels did not correlated with LAAEV or LVAs. There was significant correlations between ANP/BNP ratio and LAAEV, LVAs, or LAVI. During the 24 months follow-up, freedom from hospitalization due to heart failure was significantly lower in patients with a ANP/BNP ratio ≤ 0.65 than in those with a ANP/BNP ratio > 0.65 (94.3% versus 99.5%, P<0.01). The secretion of ANP relative to BNP decrease along with progression of left atrial remodeling in patients with AF ablation. Additionally, hospitalization due to heart failure frequently occurred in patients with low secretion of ANP relative to BNP.