The impact of B-type natriuretic peptide levels on the suppression of accompanying atrial fibrillation in Wolff-Parkinson-White syndrome patients after accessory pathway ablation

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• 作者：Mihoko Kawabata ; MD ; PhD^a ; ^{mihoko_kawabata.cvm@tmd.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Masahiko Goya ; MD ; PhD^a ; Takamitsu Takagi ; MD^b ; Shu Yamashita ; MD^c ; Shinsuke Iwai ; MD^d ; Masahito Suzuki ; MD^e ; Tomomasa Takamiya ; MD^f ; Tomofumi Nakamura ; MD^f ; Tatsuya Hayashi ; MD^g ; Atsuhiko Yagishita ; MD^c ; Takeshi Sasaki ; MD ; PhD^a ; Yoshihide Takahashi ; MD ; PhD^g ; Yuhichi Ono ; MD^h ; Hitoshi Hachiya ; MD ; PhD^b ; Yasuteru Yamauchi ; MD ; PhD^c ; Kenichiro Otomo ; MD ; PhD^h ; Junichi Nitta ; MD ; PhD^e ; Kaoru Okishige ; MD ; PhD^d ; Mitsuhiro Nishizaki ; MD ; PhD ; FJCC^f ; Yoshito Iesaka ; MD ; PhD^b ; Mitsuaki Isobe ; MD ; PhD ; FJCCⁱ ; Kenzo Hirao ; MD ; PhD^a
• 关键词：Wolff-Parkinson-White syndrome ; Atrial fibrillation ; Catheter ablation ; B-type natriuretic peptide
• 刊名：Journal of Cardiology
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：68
• 期：6
• 页码：485-491
• 全文大小：676 K

文摘

Atrial fibrillation (AF) often coexists with Wolff-Parkinson-White (WPW) syndrome. We compared the efficacy of Kent bundle ablation alone and additional AF ablation on accompanying AF, and examined which patients would still have a risk of AF after successful Kent bundle ablation.

Methods

This retrospective multicenter study included 96 patients (56 ± 15 years, 72 male) with WPW syndrome and AF undergoing Kent bundle ablation. Some patients underwent simultaneous pulmonary vein isolation (PVI) for AF. The incidence of post-procedural AF was examined.

Results

Sixty-four patients underwent only Kent bundle ablation (Kent-only group) and 32 also underwent PVI (+PVI group). There was no significant difference in the basic patient characteristics between the groups. Additional PVI did not improve the freedom from residual AF compared to Kent bundle ablation alone (p = 0.53). In the Kent-only group, AF episodes remained in 25.0% during the follow-up (709 days). A univariate analysis showed that age ≥60 years, left atrial dimension ≥38 mm, B-type natriuretic peptide (BNP) ≥40 pg/ml, and concomitant hypertension were predictive factors for residual AF. However, in the multivariate analysis, only BNP ≥40 pg/ml remained as an independent predictive factor (HR = 17.1 and CI: 2.3–128.2; p = 0.006).

Conclusions

Among patients with WPW syndrome and AF, Kent bundle ablation alone may have a sufficient clinical impact of preventing recurrence of AF in select patients. Screening the BNP level would help decide the strategy to manage those patients.