Abstract 19839: Elevated ST2 is Associated With More Extensive Atrial Remodeling and Longer Ablation Procedure Duration in Patients With Atrial Fibrillation and Flutter
Introduction: ST2 is a biomarker associated with an increased risk of ventricular arrhythmias, however its predictive role in patients with atrial arrhythmias remains unclear.
Hypothesis: We hypothesized that elevated ST2, as a marker of cardiac fibrosis, would predict more extensive structural and functional remodeling and increased ablation procedure time.
Methods: Consecutive patients with atrial fibrillation (AF) and/or atrial flutter (AFL) were enrolled and had blood drawn for measurement of plasma ST2 (Critical Diagnostics) prior to their clinically indicated pulmonary vein isolation and/or AFL ablation procedure. Echocardiographic, ECG, procedural, and historical data were recorded. Analyses were performed using SPSS v19; 2-sided p<0.05 was considered statistically significant.
Results: In total, 27 patients (mean age 62.7 ± 20.7 years, 67% male, mean left atrial volume index [LAVI] 39 ± 16 ml/m2) were enrolled (Table). ST2 levels varied by underlying arrhythmia(s). Higher log ST2 levels were associated with longer ablation procedure times (β=0.46, p=0.03). Among the 18 patients undergoing isolated AF ablation, higher log ST2 levels were associated with longer AF ablation procedure times, even after adjusting for age, sex, left atrial size (LAVI), and repeat ablation status (β=0.85, p=0.009). In the subset of patients with combined AF/AFL, ST2 levels were also associated with longer procedure times, as well as with longer AFL cycle length (r=0.89, p=0.02). Though the number of patients with elevated ST2 (>35ng/mL) was small (n=7), those with elevated ST2 had a trend toward longer AF cycle length (204 ± 36 msec vs 161 ± 41 msec, p=0.09).
Conclusions: ST2 is a marker of advanced functional remodeling in patients with AF, and is associated with significantly longer ablation procedures independent of left atrial size. Future studies are required to determine whether elevated ST2 levels predict risk of atrial arrhythmia recurrence following ablation.
Author Disclosures: J. Denysiak: None. D.E. Krummen: None. P. Anzenberg: None. J.C. Hsu: None. L.B. Daniels: Other Research Support; Modest; Critical Diagnostics, Siemens. Speakers Bureau; Modest; Roche.
- © 2016 by American Heart Association, Inc.