Pre-Procedural Serum Atrial Natriuretic Peptide Levels Predict Left Atrial Reverse Remodeling After Catheter Ablation in Patients With Atrial Fibrillation

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• 作者：Koki Nakanishi ; MD^a ; ^{knakanishi82@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Shota Fukuda ; MD^b ; Hajime Yamashita ; MD^a ; Michihiko Kosaka ; MD^a ; Naoya Shirai ; MD^a ; Atsushi Tanaka ; MD^c ; Junichi Yoshikawa ; MD^d ; Kenei Shimada ; MD^e
• 关键词：atrial fibrillation ; atrial natriuretic peptide ; multidetector computed tomography ; radiofrequency catheter ablation ; reverse remodeling
• 刊名：JACC: Clinical Electrophysiology
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：2
• 期：2
• 页码：151-158
• 全文大小：652 K

文摘

This study aimed to investigate the role of atrial natriuretic peptide (ANP) levels to predict left atrial (LA) reverse remodeling in atrial fibrillation (AF) patients.

Background

Although LA reverse remodeling after radiofrequency catheter ablation (RFCA) for AF was reported to be associated with favorable outcomes and improvement of LA and left ventricular function, the predictor has not been extensively evaluated.

Methods

This study included 104 consecutive patients who underwent RFCA for AF. All patients underwent multidetector computed tomography examination and laboratory tests, including measurement of ANP, plasma B-type natriuretic peptide (BNP), and high-sensitivity C-reactive protein (hs-CRP) levels before and 6 months after RFCA. The study population was divided according to the extent of the decrease in the LA volume index at follow-up; responders were defined as patients who exhibited a ≥15% decrease in the LA volume index.

Results

At follow-up, 49 patients (47%) were classified as responders. Pre-procedural serum ANP and BNP levels were significantly higher in the responders than in the nonresponders (both p < 0.01). In the responders, a significant decrease was observed in the log ANP, log BNP, and log hs-CRP levels from baseline to follow-up (all p < 0.01). Multivariate linear regression analysis revealed that log ANP levels before RFCA and maintenance of sinus rhythm during follow-up were independent predictors of LA reverse remodeling (both p < 0.01).

Conclusions

In this study, 47% of the patients exhibited LA reverse remodeling after RFCA for AF, with a concomitant improvement in serum ANP, BNP, and hs-CRP levels. The pre-procedural ANP level and maintenance of sinus rhythm were independently associated with LA reverse remodeling.