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Front. Physiol. | doi: 10.3389/fphys.2019.01215

Echocardiographic and Biochemical factors predicting arrhythmia recurrence after catheter ablation of atrial fibrillation - an observational study

 Emmanouil Charitakis1*,  Lars Karlsson1, Joanna-Maria Papageorgiou1, Ulla Walfridsson1 and  Carl-Johan Carlhäll1
  • 1Department of Medical and Health Sciences, Linköping University, Sweden

Background: RFA is a well-established treatment for symptomatic patients with AF. However, the success rate of a single procedure is low. We aimed to investigate the association between the risk of recurrence of atrial fibrillation (AF) after a single radiofrequency ablation (RFA) procedure and cardiac neurohormonal function, left atrial (LA) mechanical function as well as proteins related to inflammation, fibrosis and apoptosis.
Methods and Results: We studied 189 patients undergoing RFA between January 2012 and April 2014, with a follow-up period of 12 months. A logistic regression analysis was performed to investigate the association between pre-ablation LA emptying fraction (LAEF), MR-proANP, Caspase-8 (CASP8), Neurotrophin-3 (NT3), and the risk for recurrence of AF after a single RFA procedure. 119 (63.0 %) patients had a recurrence during a mean follow-up of 402±73 days.
An increased risk of recurrence was associated with: Elevated MR-proANP (fourth quartile vs. first quartile: HR, 2.80 (95% CI, 1.14-6.90]; P=0.025); Low LAEF (fourth quartile vs. first quartile: hazard ratio [HR], 2.41 [95% CI, 1.01-5.79]; P=0.045); Elevated CASP8 (fourth quartile vs. first quartile: HR 12.198 95% CI 2.216-67.129; P=0.004); Elevated NT-3 (fourth quartile vs. first quartile: HR 7.485 95% CI 1.353-41.402; P=0.021). In a receiver operating characteristic curve analysis, the combination of MR-proANP, CASP8 and NT3 produced an area under the curve of 0.819; CI 95% (0.710-0.928).
Conclusions: Patients with better LA mechanical function and lower levels of atrial neurohormones as well as of proteins related to fibrosis and apoptosis, have a better outcome after an RFA procedure.

Keywords: natriuretic peptide, Fibrosis, Apoptosis, Radiofrecuency ablation, Atrial febrillation

Received: 17 Jun 2019; Accepted: 06 Sep 2019.

Copyright: © 2019 Charitakis, Karlsson, Papageorgiou, Walfridsson and Carlhäll. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Emmanouil Charitakis, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden, mcharitakis@gmail.com