Abstract 1831: Prognostic Value of the Addition of B-Type Natriuretic Peptide and Ultra sensitive C-Reactive Protein to Left Atrial Appendage Area and Velocity by Transesophageal Echocardiography in Predicting Recurrence of Atrial Fibrillation in Patients Undergoing Pulmonary Vein Antral Isolation
Background: Pulmonary vein antral isolation (PVAI) by radiofrequency ablation is considered a cure for atrial fibrillation (AF). Following PVAI, atrial remodeling occurs with improvement in atrial function and in inflammatory and neurohormonal markers. Left atrial appendage (LAA) area and velocity, measured pre-PVAI by transesophageal echocardiography (TEE), have been used to predict recurrence of AF. We hypothesized that B-type natriuretic peptide (BNP) and ultra sensitive CRP (usCRP) may provide added prognostic value in predicting recurrence in patients undergoing PVAI.
Methods: Study population included 300 patients undergoing PVAI from 1/2004 – 12/2005. Holter monitor recordings at 6 months post PVAI were used to determine recurrence of AF. TEE (LAA diameter and area as well as emptying and filling velocities), transthoracic echocardiogram (TTE) variables and BNP and usCRP levels pre-PVAI were included in the analysis. Patients were sub-divided into 2 groups - those with AF recurrence and those without.
Results: BNP levels were elevated (116±96 vs 85±87 pg/mL, p=0.0002); LAA area was larger (5.0±1.9 vs 3.4±1.1 cm, p<0.0001); LA diameter was larger (4.7±0.9 vs 4.1±0.8 cm, p<0.0001); and LAA emptying velocity was lower (34±13 vs 43±17 cm/s, p=0.023) in patients with recurrence than those without. There was no significant usCRP difference between the 2 groups. Using multivariate analysis, LAA area by TEE had a higher positive predictive value than BNP.
Conclusions: In AF patients undergoing PVAI, LAA area and diameter showed the highest predictive value for late recurrence of AF compared to BNP and USCRP. Thus, TEE remains a key standard to assess patients undergoing PVAI.