Brian Nilsson

Prognostic impact of hs-CRP and IL-6 in patients undergoing radiofrequency catheter ablation for atrial fibrillation

Aim. The aim of this study was to assess the predictive value of inflammatory markers in patients with paroxysmal/ persistent atrial fibrillation (AF) treated with radiofrequency (RF) catheter ablation. Methods. Forty-six consecutive patients, mean age 55 years (range 31 – 81 yrs), with paroxysmal or persistent AF were treated with either segmental or circumferential pulmonary vein isolation ablation technique. All patients presented with sinus rhythm on inclusion. Holter monitoring lasting at least 14 days was performed before ablation and after 3 months. Recurrent symptomatic AF or atrial tachycardia >10 minutes was considered failure and patients were offered a second ablation session. Interleukin-6 and high-sensitivity C-reactive protein were measured prior to ablation and at follow-up visits. Results. After a maximum of two ablations, 19 patients (41%) had SR without recurrence of AF after 12 months. Patients in SR had significantly lower left atrium diameter (p = 0.007) and lower values of both IL-6 (p = 0.007) and hs-CRP (p = 0.018) at baseline before ablation. IL-6 concentration prior to ablation was an independent predictor of recurrent AF (p = 0.027). Conclusion. In patients with a history of paroxysmal or persistent AF treated with RF catheter ablation, elevated levels of IL-6 and hs-CRP before ablation are independent predictors of recurrence of AF.

Plasma YKL-40 is elevated in patients with recurrent atrial fibrillation after catheter ablation

AimTo study plasma YKL-40 in patients with atrial fibrillation (AF) treated with radiofrequency (RF) catheter ablation and to assess the predictive role of plasma YKL-40 and its changes after restoration of sinus rhythm (SR).MethodsForty-six patients (mean age 55xa0years, range 31–81) with paroxysmal/persistent AF were treated with RF catheter ablation; Holter monitoring for 14xa0days was performed before ablation and after 3xa0months. Recurrent symptomatic AF or atrial tachycardia >10xa0min was considered failure, and the patients were offered a second ablation session. YKL-40 was determined in plasma samples taken prior to ablation and at follow-up visits up to 12xa0months after ablation.ResultsAfter a maximum of two ablations, 19 patients (41%) had SR without recurrence of AF after 12xa0months. The patients with no recurrence of AF had significantly lower baseline plasma levels of YKL-40 prior to ablation compared to patients with recurrence of AF (31 vs. 62xa0μg/l, Pxa0=xa00.029). Plasma YKL-40 was not an independent predictor of recurrence of AF after ablation. No significant changes in plasma YKL-40 levels were seen from baseline to follow-up at 12xa0months.ConclusionIn patients with paroxysmal or persistent AF treated with catheter ablation, high plasma YKL-40 before ablation is associated with recurrence of AF.

Increased NT-pro-B-type natriuretic peptide independently predicts outcome following catheter ablation of atrial fibrillation.

Abstract Aims: To investigate whether NT-proBNP before ablation treatment and after exercise testing has predictive information regarding the clinical outcome following pulmonary vein isolation in patients with atrial fibrillation (AF). Methods: NT-proBNP analysis were obtained before the ablation (before and after exercise test), and repeated at 1, 3, and 12 months after the final procedure. Results: A total of 51 patients were included. At study entry, the median NT-proBNP concentration was 14.0 pmol/L (quartiles: 8.0 and 27.0). After the exercise test, the mean NT-proBNP value increased from 13.0 pmol/L (quartiles: 7.5 and 26.0) to 15.0 pmol/L (quartiles: 9.0 and 34.0), p < 0.001. Following a maximum of two ablations, 22 patients were free of AF while 29 patients experienced recurrent AF. In patients with successful ablation, the mean NT-proBNP concentration at baseline was 10.0 pmol/L (quartiles: 7.0 and 22.2) compared to 22.0 pmol/L (quartiles: 12.0 and 34.5) in patients with ablation failure, p = 0.02. With respect to exercise testing, a trend towards a higher increases during exercise were seen in patients with recurrent AF compared to patients without: 2.0 pmol/L (quartiles 1.9 and 7.0) vs. 1.5 pmol/L (quartiles 0 and 3.0), p = 0.07. A baseline NT-proBNP concentration >15.0 pmol/L was found to be an independent predictor of ablation failure. Conclusion: A significantly lower NT-proBNP concentration at baseline and a trend towards a diminished increase during exercise was seen in patients successfully ablated for AF compared to patients with recurrent AF. A baseline NT-proBNP concentration ≤15 pmol/l independently predicts ablation success.