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. 2018 Jan 2;13(1):e0189936.
doi: 10.1371/journal.pone.0189936. eCollection 2018.

Left atrial voltage, circulating biomarkers of fibrosis, and atrial fibrillation ablation. A prospective cohort study

Gordon A Begg  1   2 , Rashed Karim  3 , Tobias Oesterlein  4 , Lee N Graham  1 , Andrew J Hogarth  1 , Stephen P Page  1 , Christopher B Pepper  1 , Kawal Rhode  3 , Gregory Y H Lip  5   6 , Arun V Holden  7 , Sven Plein  2 , Muzahir H Tayebjee  1
Affiliations

Left atrial voltage, circulating biomarkers of fibrosis, and atrial fibrillation ablation. A prospective cohort study

Gordon A Begg et al. PLoS One. .

Abstract

Aims: To test the ability of four circulating biomarkers of fibrosis, and of low left atrial voltage, to predict recurrence of atrial fibrillation after catheter ablation.

Background: Circulating biomarkers potentially may be used to improve patient selection for atrial fibrillation ablation. Low voltage areas in the left atrium predict arrhythmia recurrence when mapped in sinus rhythm. This study tested type III procollagen N terminal peptide (PIIINP), galectin-3 (gal-3), fibroblast growth factor 23 (FGF-23), and type I collagen C terminal telopeptide (ICTP), and whether low voltage areas in the left atrium predicted atrial fibrillation recurrence, irrespective of the rhythm during mapping.

Methods: 92 atrial fibrillation ablation patients were studied. Biomarker levels in peripheral and intra-cardiac blood were measured with enzyme-linked immunosorbent assay. Low voltage (<0.5mV) was expressed as a proportion of the mapped left atrial surface area. Follow-up was one year. The primary endpoint was recurrence of arrhythmia. The secondary endpoint was a composite of recurrence despite two procedures, or after one procedure if no second procedure was undertaken.

Results: The biomarkers were not predictive of either endpoint. After multivariate Cox regression analysis, high proportion of low voltage area in the left atrium was found to predict the primary endpoint in sinus rhythm mapping (hazard ratio 4.323, 95% confidence interval 1.337-13.982, p = 0.014) and atrial fibrillation mapping (hazard ratio 5.195, 95% confidence interval 1.032-26.141, p = 0.046). This effect was also apparent for the secondary endpoint.

Conclusion: The studied biomarkers do not predict arrhythmia recurrence after catheter ablation. Left atrial voltage is an independent predictor of recurrence, whether the left atrium is mapped in atrial fibrillation or sinus rhythm.

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Conflict of interest statement

Competing Interests: St. Jude Medical supports Gordon Begg’s research fellowship. Gregory Lip has served as a consultant for Bayer/Jansenn, BMS/Pfizer, Biotronik, Medtronic, Boehringer Ingelheim, Microlife, and Daiichi-Sankyo, and has been a speaker for Bayer/Jansenn, BMS/Pfizer, Medtronic, Boehringer Ingelheim, Microlife, Roche and Daiichi-Sankyo. Muzahir Tayebjee has received research grants from St. Jude Medical, Medtronic, and Biosense Webster, Boehringher Ingelheim. Lee Graham and Andrew Hogarth have received honoraria from St. Jude Medical. The other authors report no conflict of interest. This does not alter our adherence to PLOS ONE policies on sharing data and materials. There are no patents, products in development or marketed products to declare.

Figures

Fig 1
Fig 1. Representative LA voltage maps of 4 separate patients.
Top row—patients mapped in AF. Bottom row—patients mapped in SR. Red areas represent <0.5mV. Left column—<30% low voltage, right column >30% low voltage.
Fig 2
Fig 2. Study outline.
Fig 3
Fig 3. Freedom from AF assessed by each endpoint, separated by LA low voltage proportion >30.0%, mapped in SR and AF.
See this image and copyright information in PMC

References

    1. Parkash R, Tang AS, Sapp JL, Wells G. Approach to the catheter ablation technique of paroxysmal and persistent atrial fibrillation: a meta-analysis of the randomized controlled trials. Journal of cardiovascular electrophysiology. 2011;22(7):729–38. doi: 10.1111/j.1540-8167.2011.02010.x . - DOI - PubMed
    1. Verma A, Jiang CY, Betts TR, Chen J, Deisenhofer I, Mantovan R, et al. Approaches to catheter ablation for persistent atrial fibrillation. The New England journal of medicine. 2015;372(19):1812–22. doi: 10.1056/NEJMoa1408288 . - DOI - PubMed
    1. Dzeshka MS, Lip GY, Snezhitskiy V, Shantsila E. Cardiac Fibrosis in Patients With Atrial Fibrillation: Mechanisms and Clinical Implications. Journal of the American College of Cardiology. 2015;66(8):943–59. doi: 10.1016/j.jacc.2015.06.1313 . - DOI - PubMed
    1. Begg GA, Holden AV, Lip GY, Plein S, Tayebjee MH. Assessment of atrial fibrosis for the rhythm control of atrial fibrillation. International journal of cardiology. 2016;220:155–61. doi: 10.1016/j.ijcard.2016.06.144 . - DOI - PubMed
    1. Verma A, Wazni OM, Marrouche NF, Martin DO, Kilicaslan F, Minor S, et al. Pre-existent left atrial scarring in patients undergoing pulmonary vein antrum isolation: an independent predictor of procedural failure. Journal of the American College of Cardiology. 2005;45(2):285–92. doi: 10.1016/j.jacc.2004.10.035 . - DOI - PubMed

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