Periprocedural decrease in tumor necrosis factor alpha is a risk factor for atrial fibrillation recurrence after ablation

Background: Concentration of tumor necrosis factor alpha (TNF-alpha) might be useful in selecting patients with paroxysmal atrial fibrillation (PAF) who will benefit the most from pulmonary vein isolation. Material and methods: This is a prospective cohort study among patients with PAF who had sinus rhythm prior to undergoing either radiofrequency ablation or cryoablation procedure. Blood samples were collected at the start of the procedure and 16-24 h after. TNF-alpha concentrations were measured. Follow-up data was obtained during a structured telephone interview and 24-hour ECG Holter monitoring 12 months after the ablation procedure. Results: Thirty seven patients were enrolled. After 12-month follow-up 27 patients maintained sinus rhythm, 8 had recurrence of AF and 2 were lost to follow-up. There was no significant correlation between TNF-alpha concentrations in any of the samples and the recurrence of arrhythmia (for pre-procedural samples: 1.75 pg/ ml vs. 1.74 pg/ml; p = 0.72; for post-procedural samples: 1.49 pg/ml vs. 1.79 pg/ml; p = 0.16). In patients who had a recurrence of AF, we observed a decrease in the periprocedural TNF-alpha concentration (-0.12 pg/ml vs 0.05 pg/ml; p = 0.05). Conclusions: Neither pre- nor post-procedural TNF-alpha concentrations are predictive of ablation outcome in patients with PAF. We observed a decrease in the periprocedural TNF-alpha concentration in patients who had AF recurrence.