Volume 4, Issue 1, March 2020, Page: 5-10
Role of NT-pro BNP Levels as a Marker of Early and Late Recurrence in Patients Submitted to Atrial Fibrillation Ablation with Normal Ventricular Function
Fabricio Vassallo, Department of Electrophysiology of Espirito Santo Cardiology Institute, Brazil and Department of Cardiology of Santa Rita Hospital of Cassia Vitoria, Vitoria, Brazil
Lucas Luis Meigre, Department of Electrophysiology of Espirito Santo Cardiology Institute, Brazil and Department of Cardiology of Santa Rita Hospital of Cassia Vitoria, Vitoria, Brazil
Christiano Cunha, Department of Electrophysiology of Espirito Santo Cardiology Institute, Brazil and Department of Cardiology of Santa Rita Hospital of Cassia Vitoria, Vitoria, Brazil
Eduardo Serpa, Department of Electrophysiology of Espirito Santo Cardiology Institute, Brazil and Department of Cardiology of Santa Rita Hospital of Cassia Vitoria, Vitoria, Brazil
Hermes Carloni, Department of Electrophysiology of Espirito Santo Cardiology Institute, Brazil and Department of Cardiology of Santa Rita Hospital of Cassia Vitoria, Vitoria, Brazil
Aloyr Simões Junior, Department of Electrophysiology of Espirito Santo Cardiology Institute, Brazil and Department of Cardiology of Santa Rita Hospital of Cassia Vitoria, Vitoria, Brazil
Flávia Pezzin, Department of Electrophysiology of Espirito Santo Cardiology Institute, Brazil and Department of Cardiology of Santa Rita Hospital of Cassia Vitoria, Vitoria, Brazil
Karla Meira, Department of Electrophysiology of Espirito Santo Cardiology Institute, Brazil and Department of Cardiology of Santa Rita Hospital of Cassia Vitoria, Vitoria, Brazil
Alberto Nogueira Junior, Department of Electrophysiology of Espirito Santo Cardiology Institute, Brazil and Department of Cardiology of Santa Rita Hospital of Cassia Vitoria, Vitoria, Brazil
Orly Lacerda Junior, Department of Electrophysiology of Espirito Santo Cardiology Institute, Brazil and Department of Cardiology of Santa Rita Hospital of Cassia Vitoria, Vitoria, Brazil
Walter Batista Junior, Department of Electrophysiology of Espirito Santo Cardiology Institute, Brazil and Department of Cardiology of Santa Rita Hospital of Cassia Vitoria, Vitoria, Brazil
Dalton Hespanhol, Department of Electrophysiology of Espirito Santo Cardiology Institute, Brazil and Department of Cardiology of Santa Rita Hospital of Cassia Vitoria, Vitoria, Brazil
Received: Dec. 21, 2019;       Accepted: Jan. 7, 2020;       Published: Jan. 21, 2020
DOI: 10.11648/j.ccr.20200401.12      View  326      Downloads  90
Abstract
BACKGROUND: Levels of NT-pro BNP has diagnostic and prognostic correlation in patients with heart failure. It is also described as a possible marker of atrial myocardial disease in patients with normal ventricular function associated with atrial fibrillation (AFib). Retrospective and prospective studies have shown that their high dosage prior and few months after AF ablation may be a risk factor for recurrence. OBJECTIVE: Determine if in patients submitted to first AFib ablation the previous levels of NT-pro BNP and at 6 and 12 months after the procedure the modification in these levels by the restoring and maintenance of sinus rhythm can identify patients at higher risk of recurrence of atrial tachyarrhythmias. METHODS AND RESULTS: From June 2015 and June 2017 we sequentially began the NT-pro BNP serial dosing in patients with paroxysmal and persistent AFib with preserved ventricular function. Levels were in the previous week, 6 and 12 months after the procedure. We prospectively analyzed 73 patients submitted to first time ablation of atrial fibrillation. In pre-procedure set 33 patients had elevated concentrations. Of these 15 (45.5%) remained elevated with a 40% recurrence rate at 12-months compared to 5.5% for those which normalized the levels. On the other hand, we had 40 patients that we considered normal NT-pro BNP levels before ablation. Of these 15 (37.5%) do not had a descent of more than 50% from baseline levels had recurrence rates of 33.3% at 12 months. The remaining 25 (62.5%) who show drops > 50% of NT-pro BNP recurrence was of only 8%. Patients who had high concentrations of NT-pro BNP or who did not present a significant decrease in these levels were, respectively, 2.25 and 2.28 times more likely to present atrial arrhythmias recurrences after catheter ablation. CONCLUSION: Our data showed that serial levels of NT-pro BNP in patients with atrial fibrillation and normal ejection fraction might identify those at higher risk of recurrence after successful catheter ablation.
Keywords
Biomarkers, NT-pro BNP, Catheter Ablation, Atrial Fibrillation, Atrial Flutter and Recurrence
To cite this article
Fabricio Vassallo, Lucas Luis Meigre, Christiano Cunha, Eduardo Serpa, Hermes Carloni, Aloyr Simões Junior, Flávia Pezzin, Karla Meira, Alberto Nogueira Junior, Orly Lacerda Junior, Walter Batista Junior, Dalton Hespanhol, Role of NT-pro BNP Levels as a Marker of Early and Late Recurrence in Patients Submitted to Atrial Fibrillation Ablation with Normal Ventricular Function, Cardiology and Cardiovascular Research. Vol. 4, No. 1, 2020, pp. 5-10. doi: 10.11648/j.ccr.20200401.12
Copyright
Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Reference
[1]
Beuttner P, Schumacher K, Dinov B, Zeynalova S, Sommer P, Bollmann A, Husser D, Hindricks G, Kornej J. Role of NT-pro ANP and NT-pro BNP in patients with atrial fibrillation: Association with atrial fibrillation progression phenotypes. Heart Rhythm 2018; 15: 1132–1137. https://doi.org/10.1016/j.hrthm.2018.03.021.
[2]
Charitakis E, Walfridsson H and Alehagen U. Short-Term Influence of Radiofrequency Ablation on NT-proBNP, MR-proANP, Copeptin, and MR-proADM in Patients with Atrial Fibrillation: Data from the Observational SMURF Study. J Am Heart Assoc. 2016; 5: e003557. https://doi.org/10.1161/JAHA.116.003557.
[3]
Macle L, Khairy P, Weerasooriya R, Novak P, Verma A, Willems S, Arentz T, Deisenhofer I, Veenhuyzen G, Scavée C, Jaïs P, Puererfellner H, Levesque S, Andrade JG, Rivard L, Guerra PG, Dubuc M, Thibault B, Talajic M, Roy D, Nattel S. Adenosine-guided pulmonary vein isolation for the treatment of paroxysmal atrial fibrillation: an international, multicentre, randomised superiority trial. Lancet. 2015 Aug 15; 386 (9994): 672–9. https://doi.org/10.1016/S0140-6736(15)60026-5.
[4]
Ministry of Health - MS National Agency of Sanitary Surveillance - ANVISA RESOLUTION OF THE BOARD OF DIRECTORS - DRC No. 9, OF FEBRUARY 20, 2015 (Published in the DOU no. 41, of March 3, 2015).
[5]
Pillarisetti J, Reddy J, Biria M, Ryschon K, Nagarajan D, Murray C, Atkins D, Bommana S, Reddy MY, Di Biase L, Pimentel R, Berenbom L, Dawn B, Natale A, Lakkireddy D. Elevated brain natriuretic peptide level in patients undergoing atrial fibrillation ablation: is it a predictor of failed ablation or a mere function of atrial rhythm and rate at a point in time? J Interv Card Electrophysiol Aug 2014, Vol. 40 Issue 2, p161-168. https://doi.org/10.1007/s10840-014-9898-7.
[6]
McLellan AJA, Kumar S, Smith C, Morton JB, Kalman JM, Kistler PM. The role of adenosine following pulmonary vein isolation in patients undergoing catheter ablation for atrial fibrillation: a systematic review. J. Cardiovasc. Electrophysiol. 2013 Jul; 24 (7): 742–51. https://doi.org/10.1111/jce.12121.
[7]
Kornej J, Apostolakis S, Bollmann A, and Lip GYH. The Emerging Role of Biomarkers in Atrial Fibrillation. Canadian Journal of Cardiology 29 (2013) 1181e1193. https://doi.org/10.1016/j.cjca.2013.04.016.
[8]
Leite LR, Santos SN, Maia H, Henz BD, Giuseppin F, Oliverira A, Zanatta AR, Peres AK, Novakoski C, Barreto JR, Vassalo F, d’Avila A and Singh SM. Luminal Esophageal Temperature Monitoring with a Deflectable Esophageal Temperature Probe and Intracardiac Echocardiography May Reduce Esophageal Injury During Atrial Fibrillation Ablation Procedures. Results of a Pilot Study. Circ Arrhythm Electrophysiol. 2011; 4: 149-156. https://doi.org/10.1161/CIRCEP.110.960328.
[9]
Danicek V, Theodorovich N, Bar-Achaim S, Miller A, Vered Z, Koren-Morag N, Uriel N, Czuriga I, Shopen A, Brantiss N and Kaluski E. Sinus Rhythm Restoration after Atrial Fibrillation: The Clinical Value of N-Terminal Pro-BNP Measurements. PACE 2008; 31: 955–960. https://doi.org/10.1111/j.1540-8159.2008.01121.x.
[10]
Calkins H, Brugada J, Packer DL, Cappato R, Chen S-A, Crijns HJG et. al. HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Personnel, Policy, Procedures and Follow-Up. A report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation Developed in partnership with the European Heart Rhythm Association (EHRA) and the European Cardiac Arrhythmia Society (ECAS); in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), and the Society of Thoracic Surgeons (STS). Endorsed and Approved by the governing bodies of the American College of Cardiology, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, and the Heart Rhythm Society. Europace (2007) 9, 335–379. https://doi.org/10.1093/europace/eum120.
[11]
Yamada T, Murakami Y, Okada T, Okamoto M, Shimizu T, Toyama J, Yoshida Y, Tsuboi N, Ito T, Muto M, Kondo T, Inden Y, Hirai M, and Murohara T. Plasma Atrial Natriuretic Peptide and Brain Natriuretic Peptide Levels After Radiofrequency Catheter Ablation of Atrial Fibrillation. Am J Cardiol 2006; 97: 1741–1744. https://doi.org/10.1016/j.amjcard.2005.12.071.
[12]
Berdague P, Caffin PY, Barazer I, Vergnes C, Sedighian S, Letrillard S, Pilossof R, Goutorbe F, Piot and Reny J-L, CH Beziers and CHU Montpellier. Use of N-terminal prohormone brain natriuretic peptide assay for etiologic diagnosis of acute dyspnea in elderly patients. Am Heart J 2006; 151: 690-8. https://doi.org/10.1016/j.ahj.2005.04.004.
[13]
Lang RM, Bierig M, Devereux RB et al (2005). Recommendations for chamber quantification: a report from the American Society of Echocardiography’s guidelines and standards committee and the chamber quantification writing group, developed in conjunction with the European Association of echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18: 1440–1463. https://doi.org/10.1016/j.euje.2005.12.014.
[14]
Wright SP, Doughty RN, Pearl A, Gamble GD, Whalley GA, Walsh HJ, Gordon G, Bagg W, Oxenham H, Yandle T, Richards M and Sharpe N. Plasma Amino-Terminal Pro-Brain Natriuretic Peptide and Accuracy of Heart-Failure Diagnosis in Primary Care. A Randomized, Controlled Trial. J Am Coll Cardiol 2003; 42: 1793– 800. doi: 10.1016/j.jacc.2003.05.011.
[15]
Lemos JA, McGuire DK, Drazner MH. B-type natriuretic peptide in cardiovascular disease. LANCET • Vol 362 • July 26, 2003. https://doi.org/10.1016/S0140-6736(03)13976-1.
[16]
Watanabe M, Murakami M, Furukawa H, Nakahara H, Tanaka H, Sunamori M. Decreased plasma brain natriuretic peptide levels after a successful Maze procedure. J Heart Valve Dis 2003; 12: 287-291.
[17]
Oral H, Knight BP, Tada H, Ozaydin M, Chugh A, Hassan S, Scharf C, Lai SWK, Greenstein R, Pelosi F, et al. Pulmonary vein isolation for paroxysmal and persistent atrial fibrillation. Circulation 2002; 105: 1077–1081. doi: 10.1161/hc0902.104712.
[18]
Wozakowska-Kaplon B, Opolski G. Atrial natriuretic peptide level after cardioversion of chronic atrial fibrillation. Int J Cardiol 2002; 83: 159–165. https://doi.org/10.1016/S0167-5273(02)00066-9.
[19]
P. J. Hunt, A. M. Richards, M. G. Nicholls, T. G. Yandle, R. N. Doughty and E. A. Espiner. Immunoreactive amino-terminal pro-brain natriuretic peptide (NT-PROBNP): a new marker of cardiac impairment. Clinical Endocrinology (1997) 47, 287–296. https://doi.org/10.1046/j.1365-2265.1997.2361058.x.
[20]
Roy D, Paillard F, Cassidy D, Bourassa MG, Gutkowska J, Genest J, Cantin M. Atrial natriuretic factor during atrial fibrillation and supraventricular tachycardia. J Am Coll Cardiol 1987; 9: 509 –514. DOI: 10.1016/S0735-1097(87)80042-6.
[21]
Rickham PP. Code of Ethics of the World Medical Association. Declaration of Helsinki. Human experimentation. Br Med J 1964; 2: 177.
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