Elevated brain natriuretic peptide level in patients undergoing atrial fibrillation ablation

Is it a predictor of failed ablation or a mere function of atrial rhythm and rate at a point in time?

Jayasree Pillarisetti, Namratha Reddy, Mazda Biria, Kay Ryschon, Darbhamulla Nagarajan, Caroline Murray, Donita Atkins, Sudharani Bommana, Madhu Yeruva Reddy, Luigi Di Biase, Rhea Pimentel, Loren Berenbom, Buddhadeb Dawn, Andrea Natale, Dhanunjaya Lakkireddy

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Pre- and postablation atrial fibrillation (AF) brain natriuretic peptide (BNP) levels were shown to predict increased recurrence of AF following ablation. Objective: Our objective was to assess whether elevated BNP levels merely represent the presence of AF at the time of measurement or indeed the true recurrence of AF. Methods and Results: In a prospective study of 88 patients undergoing AF ablation, BNP levels were measured immediately before, after, 24 h, and 4-6 months postablation. BNP levels were stratified by presenting rhythm and ventricular rate at the time of measurement. Median BNP level preablation was higher in patients presenting in AF compared to sinus rhythm (SR) (54(44-79)pg/ml vs. 30(18-47)pg/ml, p<0.001). Postablation restoration of SR in patients presenting in AF reduced median BNP levels from 54(44-79)pg/ml to 40(37-51)pg/ml, (p<0.001). However, no change was noted in patients who presented in and maintained SR throughout the procedure (30(18-47)pg/ml to 27(16-40)pg/ml, p=0.270). At 4-6 months, BNP measured in patients in SR was not significantly different from postablation BNP (35(22-53)pg/ml vs. 38(20-52)pg/ml, p=0.656), although 35 % of them had AF recurrence in 1-year follow-up. Median BNP level measured in five patients while in atrial arrhythmia was elevated compared to postablation BNP (464(421-464)pg/ml to 37(36-37)pg/ml, p=0.043). BNP levels and ventricular rates are positively correlated at all times pre- and postablation. Conclusions: BNP level rises acutely during AF and with rapid ventricular rates. BNP level seems to be a function of atrial rhythm and ventricular rate rather than short- or long-term predictor of AF ablation success.

Original languageEnglish (US)
Pages (from-to)161-168
Number of pages8
JournalJournal of Interventional Cardiac Electrophysiology
Volume40
Issue number2
DOIs
StatePublished - 2014
Externally publishedYes

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Atrial Function
Brain Natriuretic Peptide
Atrial Fibrillation
Recurrence
Ventricular Function

Keywords

  • Brain natriuretic peptide (BNP)
  • Catheter ablation and atrial fibrillation
  • Rhythm

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)
  • Medicine(all)

Cite this

Elevated brain natriuretic peptide level in patients undergoing atrial fibrillation ablation : Is it a predictor of failed ablation or a mere function of atrial rhythm and rate at a point in time? / Pillarisetti, Jayasree; Reddy, Namratha; Biria, Mazda; Ryschon, Kay; Nagarajan, Darbhamulla; Murray, Caroline; Atkins, Donita; Bommana, Sudharani; Reddy, Madhu Yeruva; Di Biase, Luigi; Pimentel, Rhea; Berenbom, Loren; Dawn, Buddhadeb; Natale, Andrea; Lakkireddy, Dhanunjaya.

In: Journal of Interventional Cardiac Electrophysiology, Vol. 40, No. 2, 2014, p. 161-168.

Research output: Contribution to journalArticle

Pillarisetti, J, Reddy, N, Biria, M, Ryschon, K, Nagarajan, D, Murray, C, Atkins, D, Bommana, S, Reddy, MY, Di Biase, L, Pimentel, R, Berenbom, L, Dawn, B, Natale, A & Lakkireddy, D 2014, 'Elevated brain natriuretic peptide level in patients undergoing atrial fibrillation ablation: Is it a predictor of failed ablation or a mere function of atrial rhythm and rate at a point in time?', Journal of Interventional Cardiac Electrophysiology, vol. 40, no. 2, pp. 161-168. https://doi.org/10.1007/s10840-014-9898-7
Pillarisetti, Jayasree ; Reddy, Namratha ; Biria, Mazda ; Ryschon, Kay ; Nagarajan, Darbhamulla ; Murray, Caroline ; Atkins, Donita ; Bommana, Sudharani ; Reddy, Madhu Yeruva ; Di Biase, Luigi ; Pimentel, Rhea ; Berenbom, Loren ; Dawn, Buddhadeb ; Natale, Andrea ; Lakkireddy, Dhanunjaya. / Elevated brain natriuretic peptide level in patients undergoing atrial fibrillation ablation : Is it a predictor of failed ablation or a mere function of atrial rhythm and rate at a point in time?. In: Journal of Interventional Cardiac Electrophysiology. 2014 ; Vol. 40, No. 2. pp. 161-168.
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abstract = "Background: Pre- and postablation atrial fibrillation (AF) brain natriuretic peptide (BNP) levels were shown to predict increased recurrence of AF following ablation. Objective: Our objective was to assess whether elevated BNP levels merely represent the presence of AF at the time of measurement or indeed the true recurrence of AF. Methods and Results: In a prospective study of 88 patients undergoing AF ablation, BNP levels were measured immediately before, after, 24 h, and 4-6 months postablation. BNP levels were stratified by presenting rhythm and ventricular rate at the time of measurement. Median BNP level preablation was higher in patients presenting in AF compared to sinus rhythm (SR) (54(44-79)pg/ml vs. 30(18-47)pg/ml, p<0.001). Postablation restoration of SR in patients presenting in AF reduced median BNP levels from 54(44-79)pg/ml to 40(37-51)pg/ml, (p<0.001). However, no change was noted in patients who presented in and maintained SR throughout the procedure (30(18-47)pg/ml to 27(16-40)pg/ml, p=0.270). At 4-6 months, BNP measured in patients in SR was not significantly different from postablation BNP (35(22-53)pg/ml vs. 38(20-52)pg/ml, p=0.656), although 35 {\%} of them had AF recurrence in 1-year follow-up. Median BNP level measured in five patients while in atrial arrhythmia was elevated compared to postablation BNP (464(421-464)pg/ml to 37(36-37)pg/ml, p=0.043). BNP levels and ventricular rates are positively correlated at all times pre- and postablation. Conclusions: BNP level rises acutely during AF and with rapid ventricular rates. BNP level seems to be a function of atrial rhythm and ventricular rate rather than short- or long-term predictor of AF ablation success.",
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T1 - Elevated brain natriuretic peptide level in patients undergoing atrial fibrillation ablation

T2 - Is it a predictor of failed ablation or a mere function of atrial rhythm and rate at a point in time?

AU - Pillarisetti, Jayasree

AU - Reddy, Namratha

AU - Biria, Mazda

AU - Ryschon, Kay

AU - Nagarajan, Darbhamulla

AU - Murray, Caroline

AU - Atkins, Donita

AU - Bommana, Sudharani

AU - Reddy, Madhu Yeruva

AU - Di Biase, Luigi

AU - Pimentel, Rhea

AU - Berenbom, Loren

AU - Dawn, Buddhadeb

AU - Natale, Andrea

AU - Lakkireddy, Dhanunjaya

PY - 2014

Y1 - 2014

N2 - Background: Pre- and postablation atrial fibrillation (AF) brain natriuretic peptide (BNP) levels were shown to predict increased recurrence of AF following ablation. Objective: Our objective was to assess whether elevated BNP levels merely represent the presence of AF at the time of measurement or indeed the true recurrence of AF. Methods and Results: In a prospective study of 88 patients undergoing AF ablation, BNP levels were measured immediately before, after, 24 h, and 4-6 months postablation. BNP levels were stratified by presenting rhythm and ventricular rate at the time of measurement. Median BNP level preablation was higher in patients presenting in AF compared to sinus rhythm (SR) (54(44-79)pg/ml vs. 30(18-47)pg/ml, p<0.001). Postablation restoration of SR in patients presenting in AF reduced median BNP levels from 54(44-79)pg/ml to 40(37-51)pg/ml, (p<0.001). However, no change was noted in patients who presented in and maintained SR throughout the procedure (30(18-47)pg/ml to 27(16-40)pg/ml, p=0.270). At 4-6 months, BNP measured in patients in SR was not significantly different from postablation BNP (35(22-53)pg/ml vs. 38(20-52)pg/ml, p=0.656), although 35 % of them had AF recurrence in 1-year follow-up. Median BNP level measured in five patients while in atrial arrhythmia was elevated compared to postablation BNP (464(421-464)pg/ml to 37(36-37)pg/ml, p=0.043). BNP levels and ventricular rates are positively correlated at all times pre- and postablation. Conclusions: BNP level rises acutely during AF and with rapid ventricular rates. BNP level seems to be a function of atrial rhythm and ventricular rate rather than short- or long-term predictor of AF ablation success.

AB - Background: Pre- and postablation atrial fibrillation (AF) brain natriuretic peptide (BNP) levels were shown to predict increased recurrence of AF following ablation. Objective: Our objective was to assess whether elevated BNP levels merely represent the presence of AF at the time of measurement or indeed the true recurrence of AF. Methods and Results: In a prospective study of 88 patients undergoing AF ablation, BNP levels were measured immediately before, after, 24 h, and 4-6 months postablation. BNP levels were stratified by presenting rhythm and ventricular rate at the time of measurement. Median BNP level preablation was higher in patients presenting in AF compared to sinus rhythm (SR) (54(44-79)pg/ml vs. 30(18-47)pg/ml, p<0.001). Postablation restoration of SR in patients presenting in AF reduced median BNP levels from 54(44-79)pg/ml to 40(37-51)pg/ml, (p<0.001). However, no change was noted in patients who presented in and maintained SR throughout the procedure (30(18-47)pg/ml to 27(16-40)pg/ml, p=0.270). At 4-6 months, BNP measured in patients in SR was not significantly different from postablation BNP (35(22-53)pg/ml vs. 38(20-52)pg/ml, p=0.656), although 35 % of them had AF recurrence in 1-year follow-up. Median BNP level measured in five patients while in atrial arrhythmia was elevated compared to postablation BNP (464(421-464)pg/ml to 37(36-37)pg/ml, p=0.043). BNP levels and ventricular rates are positively correlated at all times pre- and postablation. Conclusions: BNP level rises acutely during AF and with rapid ventricular rates. BNP level seems to be a function of atrial rhythm and ventricular rate rather than short- or long-term predictor of AF ablation success.

KW - Brain natriuretic peptide (BNP)

KW - Catheter ablation and atrial fibrillation

KW - Rhythm

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