Impact of epicardial ablation of concomitant atrial fibrillation on atrial natriuretic peptide levels and atrial function in 6 months follow-up: does preoperative ANP level predict outcome of ablation?

Journal of Cardiothoracic Surgery

Richard Feyrer⁴  Michael Weyand⁴  Miriam Freundt¹  Monika Pizon²  Norbert Friedel³  Marek Pizon⁴ 

[1] Rochester General Hospital, 1425 Portland Ave Rochester, Rochester 14621, NY, USA;Transfusion Center Bayreuth, Kurpromenade 2, 95448 Bayreuth, Germany;Department of Cardiac Surgery, Clinic of Bayreuth, Preuschwitzerstr 101, 95455 Bayreuth, Germany;Center of Cardiac Surgery, University Hospital of Erlangen, Krankenhausstr 12, 91054 Erlangen, Germany

关键词: HIFU;    Epicardial ablation;    Surgical ablation;    Atrial natriuretic peptide;    Cardiac surgery;    Atrial fibrillation;   

Others  :  814708
DOI  :  10.1186/1749-8090-8-218

 received in 2013-08-12, accepted in 2013-11-25,  发布年份 2013

【 摘 要 】

Background

Epicardial ablation concomitant to cardiac surgery is an easy and safe approach to treat atrial fibrillation (AF), but its efficacy in longstanding persistent (LsPe) AF remains intermediate. Although larger left atrial size has been associated with worse outcome after ablation, biochemical predictors of success are not well established. The aim of this study was to evaluate relationship between biochemical marker, echo-characteristic and cardiac rhythm in 6 months follow-up after epicardial ultrasound (HIFU) ablation.

Methods

We included 78 consecutive patients, who underwent elective cardiac surgery. 42 patients with AF (11.9% paroxysmal, 23.8% persistent, 64.3% LsPeAF) underwent concomitant HIFU ablation (AF ablation group), 16 with AF underwent cardiac surgery without ablation (AF control) and 20 had preoperatively normal sinus rhythm (SR control). We measured plasma ANP secretion before, on postoperative day (POD) 1, POD 7 as well as 3 and 6 months after surgery. Moreover, we estimated cardiac rhythm and atrial mechanical function by Atrial Filling Fraction (AFF) and A-wave velocity in follow-up.

Results

Baseline ANP levels were higher in patients with LsPeAF, as compared to the paroxysmal and permanent AF and to the SR control group. Patients with LsPeAF (n = 27) who converted to SR had preoperatively smaller left atrial diameter (LAD) and LA area (p < 0.05) and higher ANP level (p = 0.009) than those who remained in AF at 6 months after ablation. Multivariate regression analysis revealed that only preoperative ANP level was an independent predictor of cardiac rhythm after ablation. Patients with LsPeAF and preoperative ANP >7.5 nmol/l presented with SR in 80%, in contrast to those with ANP <7.5 nmol/l who converted to SR in 20%. We detected gradual increase of AFF and A-velocity at 6 months after ablation (p < 0.05) solely in AF ablation group. ANP levels were increased on POD 1 in ablation group (p < 0.05), without changes in further follow-up.

Conclusion

Our results indicate that preoperative ANP levels may be a new biochemical predictor of successful epicardial ablation in patients with concomitant LsPeAF. HIFU ablation caused a significant improvement of atrial mechanical function and gradual increase of AFF and did not associate with alteration of atrial endocrine secretion at 6 months follow-up.

【 授权许可】

   
2013 Pizon et al.; licensee BioMed Central Ltd.

【 图 表 】

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