Association of Preablation Plasma Corin Levels With Atrial Fibrillation Recurrence After Catheter Ablation: A Prospective Observational Study

Abstract

Background: We assessed the impact of pre- and postprocedural plasma corin levels on the recurrence of atrial fibrillation (AF) after catheter ablation (CA).

Methods and results: This prospective, single-center, observational study included patients undergoing their first CA of AF. Corin was measured before and 1 day after CA. The primary end point was recurrent AF between 3 and 12 months after ablation. From April 2019 through May 2021, we analyzed 616 patients with AF (59.09% men) with a mean age of 62.86±9.42 years. Overall, 153 patients (24.84%) experienced recurrent AF. In the recurrence group, the pre- and postprocedure corin concentrations were 539.14 (329.24-702.08) and 607.37 (364.50-753.80) pg/mL, respectively, which were significantly higher than the nonrecurrence group's respective concentrations of 369.05 (186.36-489.28) and 489.12 (315.66-629.05) pg/mL (both P<0.0001). A multivariate Cox regression analysis with confounders found that elevated preablation corin levels were significantly associated with an increased risk of AF recurrence after CA. Receiver operating characteristic curve analysis identified that a preablation corin threshold of >494.85 pg/mL predicted AF recurrence at 1 year. An increase of 1 SD in corin concentrations before CA (264.94 pg/mL) increased the risk of recurrent AF by 54.3% after adjusting for confounding variables (hazard ratio, 1.465 [95% CI, 1.282-1.655]; P<0.0001).

Conclusions: Plasma corin levels at baseline is a valuable predictor of AF recurrence after CA, independent of established conventional risk factors. Risk stratification before ablation for AF may be useful in selecting treatment regimens for patients.

Keywords: atrial fibrillation; catheter ablation; corin; natriuretic peptides; recurrence.

Figure 1. Flow diagram of inclusion and exclusion of study subjects.

AF indicates atrial fibrillation; AVNA, atrioventricular nodal ablation; CA, catheter ablation; and PM, pacemaker.

Figure 2. Pre‐ and postprocedural plasma corin levels in patients treated with catheter ablation for atrial fibrillation.

A, Total group; (B) subgroup analysis of atrial fibrillation type; (C) subgroup analysis of sex. The box diagram represents the 5% to 95% range of values. **P<0.0001.

Figure 3. The association between corin levels before and after ablation.

A, Total group; (B) nonrecurrence group; (C) recurrence group. The shaded region indicates the 95% CIs of Spearman r value.

Figure 4. Plasma corin threshold of best predictive value for recurrent atrial fibrillation at 1 year after catheter ablation.

A, Total group; (B) subgroup analysis of atrial fibrillation type; (C) subgroup analysis of sex. AUC indicates area under the curve; PaAF, paroxysmal atrial fibrillation; and PeAF, persistent atrial fibrillation.

Figure 5. Kaplan–Meier curves showing recurrent atrial fibrillation at 1 year after catheter ablation for different corin levels.

A through E, Corin levels before ablation in total, PaAF, PeAF, male and female groups; F through J, corin levels after ablation in total, PaAF, PeAF, male and female. HR indicates hazard ratio; PaAF, paroxysmal atrial fibrillation; and PeAF, persistent atrial fibrillation.

Figure 6. Hazard ratios with 95% CIs for 1 SD increase in corin concentration of recurrent atrial fibrillation at 1 year after catheter ablation.

A, Crude model; (B) adjusted model (adjusted for age, sex, body mass index, triglyceride, high‐density lipoprotein cholesterol, antiarrhythmic drugs, β‐blockers and corin levels before or after catheter ablation). HR indicates hazard ratio; PaAF, paroxysmal atrial fibrillation; and PeAF, persistent atrial fibrillation. **P<0.0001.

Figure 7. Predictors of recurrent atrial fibrillation at 1 year after catheter ablation in adjusted models.

Adjusted for age, sex, body mass index, triglyceride, high‐density lipoprotein cholesterol, antiarrhythmic drugs, β‐blockers, and corin levels before or after catheter ablation. The continuous variables were log‐transformed and 1 SD was used for odds ratio calculation. AADs indicates antiarrhythmic drugs; AF, atrial fibrillation; BMI, body mass index; HDL‐C, high‐density lipoprotein cholesterol; OR, odds ratio; PaAF, paroxysmal atrial fibrillation; PeAF, persistent atrial fibrillation; and TG, triglyceride. **P<0.0001.