af ablation

atrial fibrosis

natriuretic peptide

patients atrial fibrillation

atrial fibrillation af

pulmonary vein

catheter ablation

bnp nt-probnp

systolic bp

atrial fibrillation patients

Canadian Journal of Cardiology

Radiofrequency catheter ablation for atrial fibrillation (AF) has developed into a mainstay therapy. The recent Substrate Modification with Aggressive Blood Pressure Control (SMAC-AF) randomized controlled trial did not find that reducing blood pressure prior to ablation reduced recurrence of AF. There has been developing interest in NT-proBNP being a biomarker that could predict ablation success. We investigated the effect of baseline NT-proBNP on recurrence in patients enrolled in SMAC-AF. The randomized nature of the study also allowed us to investigate how this effect differed with aggressive versus standard blood pressure management. The SMAC-AF study included 173 hypertensive patients (defined as >130/80mmHg), resistant or intolerant to at least one class I or III antiarrhythmic drug, and scheduled to undergo catheter ablation. Patients were randomized to undergo aggressive (<120/80mmHg) or standard blood pressure management (<140/90mmHg), up to 6 months before ablation. The primary outcome was time to symptomatic AF, atrial tachycardia, or atrial flutter, at >3 months after ablation. We examined the effect of baseline NT-proBNP on the primary outcome. Of the 173 patients, 88 were randomized to the aggressive cohort, and 85 into the standard group. The primary outcome occurred in 61.4% of those in the aggressive arm, versus 61.2% in the standard arm. There was no difference in baseline NT-proBNP, LVEF, age, and baseline systolic pressure between aggressive and standard groups. Baseline NT-proBNP was associated with age, LVEF, and AF type. In the aggressive group, logNT-proBNP predicted recurrence (HR 1.28, p=0.04), while in the standard cohort, it did not (HR 0.94, p=0.62). Controlling for baseline characteristics, logNT-proBNP still remained a significant predictor of recurrent AF (HR 1.41, p=0.03) in the aggressive cohort, but not in the standard group (HR 0.94, p=0.62). Stratifying with a cutoff of 280 pg/mL, those in the aggressive group with higher baseline BNP had higher AF recurrence than those with ...

NT-PROBNP PREDICTS RECURRENCE AFTER CATHETER ABLATION IN A HYPERTENSIVE POPULATION UNDERGOING AGGRESSIVE BLOOD PRESSURE MANAGEMENT: A SUB-STUDY OF SMAC-AF