Abstract
BACKGROUND: Levels of NT-pro BNP has diagnostic and prognostic correlation in patients with heart failure. It is also described as a possible marker of atrial myocardial disease in patients with normal ventricular function associated with atrial fibrillation (AFib). Retrospective and prospective studies have shown that their high dosage prior and few months after AF ablation may be a risk factor for recurrence. OBJECTIVE: Determine if in patients submitted to first AFib ablation the previous levels of NT-pro BNP and at 6 and 12 months after the procedure the modification in these levels by the restoring and maintenance of sinus rhythm can identify patients at higher risk of recurrence of atrial tachyarrhythmias. METHODS AND RESULTS: From June 2015 and June 2017 we sequentially began the NT-pro BNP serial dosing in patients with paroxysmal and persistent AFib with preserved ventricular function. Levels were in the previous week, 6 and 12 months after the procedure. We prospectively analyzed 73 patients submitted to first time ablation of atrial fibrillation. In pre-procedure set 33 patients had elevated concentrations. Of these 15 (45.5%) remained elevated with a 40% recurrence rate at 12-months compared to 5.5% for those which normalized the levels. On the other hand, we had 40 patients that we considered normal NT-pro BNP levels before ablation. Of these 15 (37.5%) do not had a descent of more than 50% from baseline levels had recurrence rates of 33.3% at 12 months. The remaining 25 (62.5%) who show drops > 50% of NT-pro BNP recurrence was of only 8%. Patients who had high concentrations of NT-pro BNP or who did not present a significant decrease in these levels were, respectively, 2.25 and 2.28 times more likely to present atrial arrhythmias recurrences after catheter ablation. CONCLUSION: Our data showed that serial levels of NT-pro BNP in patients with atrial fibrillation and normal ejection fraction might identify those at higher risk of recurrence after successful catheter ablation.
Highlights
Introduction and ObjectiveBrain Natriuretic Peptide (BNP) has been identified and described since 1988 in pig brains and has structural and functional similarity to another hormone, the Atrial Natriuretic Peptide (ANP)
As all patients was submitted to ablation for having symptomatic atrial fibrillation (AFib) we considered recurrence if the patient had suggestive symptoms with an electrocardiogram or Holter tracings of atrial tachyarrhythmias
Group A consisted of 33 patients who had abnormally high levels of NT-pro BNP pre-ablation with an average of 448.2±187pg/dl since the normal level was accepted as 200pg/dl in this study [7, 14, 15]
Summary
Introduction and ObjectiveBrain Natriuretic Peptide (BNP) has been identified and described since 1988 in pig brains and has structural and functional similarity to another hormone, the Atrial Natriuretic Peptide (ANP). Submitted to Atrial Fibrillation Ablation with Normal Ventricular Function right ventricular disorders and as an etiological diagnosis of dyspnea [12] Associated with these factors, the prognostic values and therapeutic potentials of the hormone were documented. In other circumstances such as AFib which is characterized primarily by electrical remodeling and atrial contractility deterioration the inappropriately rapid ventricular response, loss of the atrial contribution to the cardiac output, and atrial overloading lead to neurohormonal system activation and elevation of ANP and BNP [20] (figure 1). Levels of NT-pro BNP has diagnostic and prognostic correlation in patients with heart failure It is described as a possible marker of atrial myocardial disease in patients with normal ventricular function associated with atrial fibrillation (AFib). CONCLUSION: Our data showed that serial levels of NT-pro BNP in patients with atrial fibrillation and normal ejection fraction might identify those at higher risk of recurrence after successful catheter ablation
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