Carballo David, Noble Stephane, Carballo Sebastian, Stirnemann Jérome, Muller Hajo, Burri Haran, Vuilleumier Nicolas, Talajic Mario, Tardif Jean-Claude, Keller Pierre-Frederic, Mach Francois, Shah Dipen
1 Division of Cardiology, Geneva University Hospitals, Geneva, Switzerland.
2 Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland.
J Int Med Res. 2018 Dec;46(12):5183-5194. doi: 10.1177/0300060518793807. Epub 2018 Sep 4.
Atrial fibrillation (AF) is the most common cardiac arrhythmia, and radiofrequency catheter ablation of AF (RCAAF) has become increasingly popular. Cardiac stress and inflammation have been associated with AF. This study was performed to determine whether the pre- or post-AF ablation levels of high-sensitivity C-reactive protein (hs-CRP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are predictive of AF recurrence.
This multicenter prospective cohort study involved patients undergoing RCAAF in Switzerland and Canada. The primary endpoint was the recurrence of AF or atrial flutter at 6 months.
Of 202 patients, 195 completed follow-up (age, 57.5 ± 9 years; mean left ventricular ejection fraction, 62%; mean left atrial size, 19.4 cm). Patients with AF recurrence had larger atrial surfaces and longer total RCAAF times. Both the pre-ablation hs-CRP level and 1-day post-RCAAF NT-proBNP level were significantly associated with an increased risk of recurrence.
The pre-ablation hs-CRP level and immediate post-ablation NT-proBNP level were markers for atrial arrhythmia recurrence after RCAAF. This confirms growing evidence of the role of inflammation in the pathogenesis of AF. These biomarkers appear to be promising stratification tools for selection and management of patients undergoing RCAAF.
心房颤动（AF）是最常见的心律失常，房颤的射频导管消融术（RCAAF）越来越受欢迎。心脏应激和炎症与房颤有关。本研究旨在确定房颤消融术前或术后高敏C反应蛋白（hs-CRP）和N末端B型利钠肽原（NT-proBNP）水平是否可预测房颤复发。
这项多中心前瞻性队列研究纳入了在瑞士和加拿大接受RCAAF的患者。主要终点是6个月时房颤或房扑的复发。
202例患者中，195例完成随访（年龄57.5±9岁；平均左心室射血分数62%；平均左心房大小19.4 cm）。房颤复发患者的心房面积更大，RCAAF总时间更长。消融术前hs-CRP水平和RCAAF术后1天的NT-proBNP水平均与复发风险增加显著相关。
消融术前hs-CRP水平和消融术后即刻NT-proBNP水平是RCAAF术后房性心律失常复发的标志物。这证实了炎症在房颤发病机制中作用的证据越来越多。这些生物标志物似乎是用于接受RCAAF患者选择和管理的有前景的分层工具。
