Department of Cardiology, Mitsubishi Kyoto Hospital.
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University.
Circ J. 2023 Nov 24;87(12):1730-1739. doi: 10.1253/circj.CJ-23-0263. Epub 2023 Sep 22.
This study assessed the prognostic importance of B-type natriuretic peptide (BNP) concentrations for clinical events after catheter ablation for atrial fibrillation (AF).
We enrolled 1,750 consecutive patients undergoing initial AF ablation whose baseline BNP data were available from a large-scale multicenter observational cohort (TRANQUILIZE-AF Registry). The prognostic impact of BNP concentration on clinical outcomes, including recurrent tachyarrhythmias and a composite of heart failure (HF) hospitalization or cardiac death, was evaluated. Median baseline BNP was 94.2 pg/mL. During a median follow-up of 2.4 years, low BNP (<38.3 pg/mL) was associated with lower rates of recurrent atrial tachyarrhythmias than BNP concentrations ≥38.3 pg/mL (19.9% vs. 30.6% at 3 years; P<0.001) and HF (0.8% vs. 5.3% at 3 years; P<0.001). Multivariable Cox regression analyses revealed that low BNP was independently associated with lower risks of arrhythmia recurrence (hazard ratio [HR] 0.63; 95% confidence interval [CI] 0.47-0.82; P<0.001) and HF (HR 0.17; 95% CI 0.04-0.71; P=0.002). The favorable impact of low BNP on arrhythmia recurrence was prominent in patients with paroxysmal, but not non-paroxysmal, AF, particularly among those with long-standing AF.
Low BNP concentrations had a favorable impact on clinical outcomes after AF ablation. The heterogeneous impact of baseline BNP concentrations on arrhythmia recurrence for the subgroups of patients divided by AF type warrants future larger studies with longer follow-up periods.
本研究评估了 B 型利钠肽（BNP）浓度对心房颤动（AF）导管消融后临床事件的预后意义。
我们纳入了 1750 例接受初始 AF 消融的连续患者，其基线 BNP 数据可从一项大型多中心观察队列（TRANQUILIZE-AF 登记处）获得。评估了 BNP 浓度对临床结局（包括复发性快速性心律失常和心力衰竭（HF）住院或心脏死亡的复合终点）的预后影响。中位基线 BNP 为 94.2pg/ml。在中位 2.4 年的随访期间，低 BNP（<38.3pg/ml）与复发性心房快速性心律失常的发生率低于 BNP 浓度≥38.3pg/ml（3 年时为 19.9% vs. 30.6%；P<0.001）和 HF（3 年时为 0.8% vs. 5.3%；P<0.001）相关。多变量 Cox 回归分析显示，低 BNP 与心律失常复发的风险降低独立相关（风险比[HR]0.63；95%置信区间[CI]0.47-0.82；P<0.001）和 HF（HR 0.17；95%CI 0.04-0.71；P=0.002）。低 BNP 对心律失常复发的有利影响在阵发性而非非阵发性 AF 患者中更为显著，尤其是在持续性 AF 患者中。
低 BNP 浓度对 AF 消融后临床结局有积极影响。根据 AF 类型分组的患者亚组中，基线 BNP 浓度对心律失常复发的影响存在异质性，需要进一步进行更大规模、随访时间更长的研究。
