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. 2023 Jun 2;25(6):euad149.
doi: 10.1093/europace/euad149.

Association of bone morphogenetic protein 10 and recurrent atrial fibrillation after catheter ablation

Elisa Hennings  1   2 , Stefanie Aeschbacher  1   2 , Michael Coslovsky  3 , Rebecca E Paladini  1   2 , Pascal B Meyre  1   2 , Gian Voellmin  1   2 , Livia Blum  1   2 , Peter Kastner  4 , André Ziegler  5 , David Conen  6 , Christine S Zuern  1   2 , Philipp Krisai  1   2 , Patrick Badertscher  1   2 , Christian Sticherling  1   2 , Stefan Osswald  1   2 , Sven Knecht  1   2 , Michael Kühne  1   2
Affiliations

Association of bone morphogenetic protein 10 and recurrent atrial fibrillation after catheter ablation

Elisa Hennings et al. Europace. .

Abstract

Aims: Atrial remodelling, defined as a change in atrial structure, promotes atrial fibrillation (AF). Bone morphogenetic protein 10 (BMP10) is an atrial-specific biomarker released to blood during atrial development and structural changes. We aimed to validate whether BMP10 is associated with AF recurrence after catheter ablation (CA) in a large cohort of patients.

Methods and results: We measured baseline BMP10 plasma concentrations in AF patients who underwent a first elective CA in the prospective Swiss-AF-PVI cohort study. The primary outcome was AF recurrence lasting longer than 30 s during a follow-up of 12 months. We constructed multivariable Cox proportional hazard models to determine the association of BMP10 and AF recurrence. A total of 1112 patients with AF (age 61 ± 10 years, 74% male, 60% paroxysmal AF) was included in our analysis. During 12 months of follow-up, 374 patients (34%) experienced AF recurrence. The probability for AF recurrence increased with increasing BMP10 concentration. In an unadjusted Cox proportional hazard model, a per-unit increase in log-transformed BMP10 was associated with a hazard ratio (HR) of 2.28 (95% CI 1.43; 3.62, P < 0.001) for AF recurrence. After multivariable adjustment, the HR of BMP10 for AF recurrence was 1.98 (95% CI 1.14; 3.42, P = 0.01), and there was a linear trend across BMP10 quartiles (P = 0.02 for linear trend).

Conclusion: The novel atrial-specific biomarker BMP10 was strongly associated with AF recurrence in patients undergoing CA for AF.

Clinicaltrials.gov identifier: NCT03718364; https://clinicaltrials.gov/ct2/show/NCT03718364.

Keywords: Atrial fibrillation; BMP10; Biomarker; Bone morphogenetic protein 10; Catheter ablation; Pulmonary vein isolation.

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Conflict of interest statement

Conflict of interest: P.B. received research funding from the University of Basel, the ‘Stiftung für Herzschrittmacher und Elektrophysiologie’, the ‘Freiwillige Akademische Gesellschaft Basel’, and the Swiss Heart Foundation and Johnson&Johnson, all outside the submitted work, and reports personal fees from Abbott, Boston Scientific, and Pfizer BMS. D.C. received consultancy fees from Roche Diagnostics and Trimedics and speaker fees from Servier and BMS/Pfizer. S.K. received funding from the ‘Stiftung für Herzschrittmacher und Elektrophysiologie’. M.K. received personal fees from Daiichi Sankyo and grants from the Swiss National Science Foundation, Swiss Heart Foundation, Foundation for CardioVascular Research Basel, Bayer, Pfizer, Boston Scientific, BMS, Biotronik, and Daiichi Sankyo. S.O. received research grants from the Swiss National Science Foundation and Swiss Heart Foundation, Foundation for CardioVascular Research Basel, and F. Hoffmann-La Roche Ltd and educational and speaker grants from F. Hoffmann-La Roche Ltd, Bayer, Novartis, Sanofi, AstraZeneca, Daiichi Sankyo, and Pfizer. C.S. is a member of the Advisory Board of Medtronic Europe and Advisory Board of Boston Scientific Europe and has received educational grants from Biosense Webster and Biotronik, research grants from the European Union’s FP7 program and Biosense Webster, and lecture and consulting fees from Abbott, Medtronic, Biosense Webster, Boston Scientific, Micro-Port, and Biotronik. All remaining authors have declared no conflicts of interest.

Figures

Graphical Abstract
Graphical Abstract
AF, atrial fibrillation; BMP10, bone morphogenetic protein 10; HR, hazard ratio
Figure 1
Figure 1
Kaplan–Meier curve for freedom from AF recurrence. Freedom from AF recurrence per follow-up days after catheter ablation according to BMP10 quartiles. P-value was calculated by log-rank test. AF, atrial fibrillation; BMP10, bone morphogenetic protein 10.
Figure 2
Figure 2
Observed AF recurrence rate in the BMP10 quartiles. Percentage of patients with documented AF recurrence in the respective BMP10 quartiles. AF, atrial fibrillation; BMP10, bone morphogenetic protein 10.
Figure 3
Figure 3
Predicted probabilities of AF recurrence according to BMP10 concentration. The probability for AF recurrence was calculated using logistic regression for unadjusted model 1 and multivariable adjusted model 3. Model 3 was calculated for an ‘average patient’: male, age 61 years, body mass index 27 kg/m2, history of hypertension, no history of coronary artery disease, no history of heart failure, no history of diabetes, no history of stroke, and no history of renal failure. AF, atrial fibrillation; BMP10, bone morphogenetic protein 10.
Figure 4
Figure 4
Association of BMP10 and AF recurrence across various subgroups. Adjusted HRs (95% CI) of BMP10 for AF recurrence in the different subgroups were calculated using multivariable adjusted Cox proportional hazard models (model 3). AF, atrial fibrillation; BMP10, bone morphogenetic protein 10; CI, confidence intervals; HR, hazard ratio; LA dimension (PLAX), left atrial dimension in the parasternal long-axis; LVEF, left ventricular ejection fraction; No., number.
See this image and copyright information in PMC

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