Myeloperoxidase and N-terminal proatrial natriuretic peptide as predictors for atrial fibrillation recurrence in patients undergoing redo ablation

Background

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.

Objective

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.

Methods

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).

Results

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, P = .010; and AUC 0.752, 95% CI 0.551–0.953, P = .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, P = .005; and ρ = 0.362, P = .005). While MPO was associated with atrial fibrosis in the endocardial map (ρ = 0.280, P = .024), NT-proANP correlated with left atrial volume index (ρ = 0.256, P = .037). There were no significant differences in biomarkers concentrations with regard to venous and coronary sinus samples.

Conclusion

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.