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High Brain Natriuretic Peptide Level Predicts The Prevalence Of Low-Voltage Areas And Poor Rhythm Outcome In Patients Undergoing Atrial Fibrillation Ablation


Backgrounds:The prevalence of residual left atrial low-voltageareas (LVAs) is associated with atrial fibrillation (AF) recurrence after pulmonary vein isolation. Brain natriuretic peptide (BNP) may be increased in AF patients and may raise AF recurrence risk after catheter ablation.We investigated the association between BNP and the prevalence of LVAs. Methods: One hundred and eighty three consecutive AF caseswere retrospectively enrolled that underwent initial ablation for AF (persistent AF, 82 [45%] patients). Serum BNP was measured before ablation and the natural logarithm of BNP (log-BNP) was calculated. Low-voltage points were defined as sites with left atrial electrogram amplitude <0.5 mV. LVAs were defined as regions with ≥5% low-voltage points across the total surface area of the left atrium. Results:Of the 183 patients, 38 (21%) had LVAs. Patients with LVAs demonstrated higher log-BNP(4.8±0.9vs. 3.9±1.2, P<0.001). The optimal cut-off value of log-BNPwas 4.4, which was equivalent to 81 pg/mL of BNP. LVAswere more frequent in patients with higher log-BNP. In multivariate analysis,log-BNP>4.4was an independent predictor of LVAs(odds ratio 2.7 [95% confidence interval 1.01–7.1], P=0.048).Freedom from AF recurrence was significantly lower in patients with than without high log-BNP (P=0.007). Conclusions:BNP correlated with the prevalence of left atrial LVAsand AF recurrence in patients with AF undergoing catheter ablation.

Credits: Yasuhiro Matsuda, MD, Masaharu Masuda, MD, PhD*, Mitsutoshi Asai, MD, PhD, Osamu Iida, MD, Shin Okamoto, MD, Takayuki Ishihara, MD, Kiyonori Nanto, MD, Takashi Kanda, MD, Takuya Tsujimura, MD, Shota Okuno, MD, Yosuke Hata, MD, Hiroyuki Uematsu, MD, and Toshiaki Mano, MD, PhD


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