Department of Cardiology and Cardiovascular Diseases, Eberhard Karls University, Tübingen, Germany.
Circ Arrhythm Electrophysiol. 2018 Jun;11(6):e006242. doi: 10.1161/CIRCEP.118.006242.
Atrial fibrosis is a hallmark of arrhythmogenic structural remodeling in patients with persistent atrial fibrillation (AF) and is negatively correlated with procedure outcome in patients undergoing ablation. However, noninvasive methods to determine the extent of atrial fibrosis are limited. Here, we used microRNA (miRNA) expression analysis to detect markers of left atrial low-voltage areas (LVAs) in patients with persistent AF undergoing catheter ablation.
We performed 3-dimensional voltage mapping in 102 patients (average age 62.1±13.1 years, CHADS-VASc score of 2.3±1.6, LA size 41.5±5.7 mm) undergoing ablation for persistent AF and determined the extent of left atrial low-voltage. LVAs were defined if bipolar electrogram amplitudes were <0.5 mV during sinus rhythm. Before ablation, we obtained a blood sample, isolated miRNAs, and profiled them on a miRCURY LNA Universal RT microRNA PCR Human panel.
Sixty-nine miRNAs were identified in all samples, with an average of 123 miRNAs detectable per sample. We found that the serum concentration of miR-21, a miRNA that has been previously linked to cardiac fibrosis development, was strongly associated with the extent of LVAs determined by voltage mapping. We could confirm that LVAs were negatively correlated with ablation success in a 1-year follow-up. In addition, miR-21 serum levels were associated with AF-free survival after catheter ablation.
Circulating miR-21 correlates with left atrial LVAs and is associated with procedure outcome in patients with persistent AF undergoing ablation.
心房纤维化是持续性心房颤动（AF）患者心律失常结构重构的标志，与消融治疗患者的手术结果呈负相关。然而，目前尚无确定心房纤维化程度的非侵入性方法。在这里，我们使用 microRNA（miRNA）表达分析来检测接受导管消融治疗的持续性 AF 患者左心房低电压区（LVA）的标志物。
我们对 102 例（平均年龄 62.1±13.1 岁，CHADS-VASc 评分为 2.3±1.6，左心房大小 41.5±5.7mm）接受持续性 AF 消融治疗的患者进行了 3 维电压标测，并确定了左心房低电压的范围。如果窦性心律时双极电图幅度<0.5mV，则定义为 LVA。在消融前，我们采集了一份血样，分离了 miRNA，并在 miRCURY LNA 通用 RT microRNA PCR 人类面板上对其进行了分析。
在所有样本中鉴定出 69 个 miRNA，每个样本平均可检测到 123 个 miRNA。我们发现，miR-21 的血清浓度与电压标测确定的 LVA 范围强烈相关，miR-21 是一种先前与心脏纤维化发展相关的 miRNA。我们可以证实，在 1 年的随访中，LVA 与消融成功呈负相关。此外，miR-21 血清水平与导管消融后的 AF 无复发生存相关。
循环 miR-21 与左心房 LVA 相关，并与接受消融治疗的持续性 AF 患者的手术结果相关。
