Abstract
Galectin-3 is a biomarker of fibrosis and atrial remodeling, involved in the mechanisms of initiation and maintenance of atrial fibrillation (AF). We sought to study the accuracy of galectin-3 level in predicting recurrences of AF after ablation. Serum concentrations of galectin-3 were determined in a consecutive series of patients addressed for AF ablation in our center. After a 3-month blanking period, recurrences of atrial arrhythmias were collected during the first year in all patients, using Holter monitoring at 3, 6 months and 12 months. A total of 160 patients were included, with a mean galectin-3 rate was 14.4 ± 5.6 ng/mL. At 12-month, 55 patients (34%) had reexperienced sustained atrial arrhythmia. Only higher galectin-3 level (HR = 1.07 [1.01–1.12], p = 0.02) and larger left atrial diameter (HR = 1.07 [1.03–1.12], p = 0.001) independently predicted recurrence. Patients with both galectin-3 level <15 ng/mL and left atrial diameter <40 millimeters had a 1-year arrhythmia-free survival rate − after a single procedure without anti-arrhythmic drug − of 91%, as compared with 41% in patients with galectin-3 ≥ 15 and left trial diameter ≥40 (p < 0.0001), whether AF was paroxysmal or persistent. Galectin-3 and left atrial diameters, rather than clinical presentation of AF, predict recurrences after ablation.
Highlights
MethodsWhen return to sinus rhythm was obtained, either with ablation, or with electrical cardioversion at the end of procedure, bidirectional block was confirmed on all performed lines
Ablation of atrial fibrillation (AF) is a recommended therapy in symptomatic patients, when appropriate[1]
We identified only 2 independent predictive factors of recurrence, and both are linked with structural atrial remodeling: LA diameter (LAD) and Gal-3 level
Summary
When return to sinus rhythm was obtained, either with ablation, or with electrical cardioversion at the end of procedure, bidirectional block was confirmed on all performed lines. Recurrence was defined as ≥1 documented sustained episode (≥3 0 seconds) of any atrial arrhythmia, symptomatic or not, on any ECG or Holter monitoring strip (scheduled or additional), after a single ablation procedure, after a 3-month blanking period. Antiarrhythmic drugs were continued in most of the patients, and a cardioversion was performed in the event of persistent recurrence. A 7-day Holter recording was systematically performed at 12 months (Spiderview, Sorin Group, Le Plessis-Robinson, France). The main confounding factors were tested in univariable analysis, and parameters significantly associated with recurrence (p-value < 0.05) were used for analyses in the multivariable model.
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