Bannehr Marwin, Georgi Christian, Edlinger Christoph, Paar Vera, Jankowska Paulina, Lichtenauer Michael, Haase-Fielitz Anja, Seifert Martin, Butter Christian
Department of Cardiology, University Hospital Heart Centre Brandenburg, Brandenburg Medical School (MHB) Theodor Fontane, Bernau/Neuruppin, Germany.
Faculty of Health Sciences, Joint Faculty of the University of Potsdam, the Brandenburg Medical School Theodor Fontane, and the Brandenburg Technical University Cottbus-Senftenberg, Cottbus, Germany.
Heart Rhythm O2. 2024 Sep 13;5(11):770-777. doi: 10.1016/j.hroo.2024.09.003. eCollection 2024 Nov.
Atrial fibrillation (AF) is a progressively developing arrhythmia. Electroanatomic remodeling may play an important role, both in the development of the disease and in the perpetuation and thus in the recurrence of AF.
This study aimed to investigate potential biomarkers myeloperoxidase (MPO), N-terminal proatrial natriuretic peptide (NT-proANP), intercellular adhesion molecule-1, and matrix metalloproteinase-2 and their predictive value for AF recurrence in patients undergoing redo ablation.
In this single-center prospective cohort study, 50 consecutive patients underwent ultra high-density mapping and redo ablation. Biomarkers were determined before ablation and at 6-month follow-up. Seven-day Holter was conducted to check for AF recurrence (>30 seconds).
Eleven (22%) patients showed AF recurrence after redo ablation. Receiver-operating characteristic curve analysis revealed venous MPO and NT-proANP (area under the curve [AUC] 0.755, 95% CI 0.599-0.912, .010; and AUC 0.752, 95% CI 0.551-0.953, .011) as acceptable predictors for intermediate AF recurrence, whereas matrix metalloproteinase-2, intercellular adhesion molecule-1, and established cardiovascular biomarkers such as N-terminal pro-B-type natriuretic peptide, troponin T, and C-reactive protein were not (all AUC <0.600). MPO and NT-proANP correlated with AF burden (ρ = 0.365, .005; and ρ = 0.362, .005). While MPO was associated with atrial fibrosis in the endocardial map (ρ = 0.280, .024), NT-proANP correlated with left atrial volume index (ρ = 0.256, .037). There were no significant differences in biomarkers concentrations with regard to venous and coronary sinus samples.
MPO and NT-proANP are of predictive value for AF recurrence in patients undergoing redo ablation. While MPO correlated with endocardial fibrosis, NT-proANP was associated with left atrial volume.
心房颤动（AF）是一种渐进性发展的心律失常。电解剖重塑可能在该疾病的发生发展、持续存在以及AF复发中发挥重要作用。
本研究旨在探究潜在生物标志物髓过氧化物酶（MPO）、N端前心钠素（NT-proANP）、细胞间黏附分子-1和基质金属蛋白酶-2及其对接受再次消融的患者AF复发的预测价值。
在这项单中心前瞻性队列研究中，50例连续患者接受了超高密度标测和再次消融。在消融前及随访6个月时测定生物标志物。进行7天动态心电图检查以检测AF复发（>30秒）。
11例（22%）患者在再次消融后出现AF复发。受试者工作特征曲线分析显示静脉血MPO和NT-proANP（曲线下面积[AUC]分别为0.755，95%可信区间0.59至0.912，P = 0.010；以及AUC 0.752，95%可信区间0.55至0.953，P = 0.011）可作为AF中期复发的可接受预测指标，而基质金属蛋白酶-2、细胞间黏附分子-1以及已确立的心血管生物标志物如N端前B型脑钠肽、肌钙蛋白T和C反应蛋白则不然（所有AUC<0.600）。MPO和NT-proANP与AF负荷相关（ρ = 0.365，P = 0.005；以及ρ = 0.362，P = 0.005）。虽然MPO与心内膜标测中的心房纤维化相关（ρ = 0.280，P = 0.024），但NT-proANP与左心房容积指数相关（ρ = 0.256，P = 0.037）。静脉血和冠状窦样本的生物标志物浓度无显著差异。
MPO和NT-proANP对接受再次消融的患者AF复发具有预测价值。MPO与心内膜纤维化相关，而NT-proANP与左心房容积相关。
