Predictors of atrial fibrillation recurrence after radiofrequency pulmonary vein isolation: metabolic syndrome, epicardial fat thickness, what else?

Abstract Aim To establish association of metabolic syndrome (MS), epicardial fat thickness (EFT), concentration of galectin-3 and transforming growth factor-beta1 (TGF-b1) in blood serum with atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI). Materials and methods Ninety five (n = 95) of 258 examined patients with AF underwent PVI due to ineffectiveness of the antiarrhythmic therapy. Average patient age was 54.2 ± 8.2 years. MS was diagnosed according to International Diabetes Federation (IDF) criteria. EFT was detected by means of transthoracic echocardiography. Galectin-3 and TGF-b1 serum levels were determined by enzyme-linked immunosorbent assay (ELISA). Results After one year of prospective post-PVI observation all patients were divided into 2 groups: Group I included 59 patients (62.1%) without arrhythmia recurrence, and Group II comprised 36 patients (37.9%) with AF recurrence. MS prevalence reached 80.6% among patients with AF relapse and only 33.9% – in patients without AFrecurrence. EFT in patients with AF recurrence was greater than in patients without AF recurrence (5.8 ± 1.8 mm and 4.9 ± 1.9 mm, p = 0.0187). Galectin-3 concentration in patients with AF recurrence was higher than in patients without AF recurrence (0.85 0.68; 0.96 ng / ml and 0.72 0.62; 0.85 ng / ml, p = 0.01). The concentration of TGF-b1 did not significantly differ in patients with and without AF recurrence (3586.9 1841.0; 5545.8 pg/ml and 2581.3 1896.4; 3177.4 pg/ml, p = 0.21). Logistic regression method allowed us to establish that the risk of AF recurrence after PVI was 8-hold higher in patients with MS (OS = 8.08, 95% CI 3.01-21.65; p = 0.001). According to the ROC analysis, the EFT threshold value of 4.5 mm or more (AUC = 0.653 ± 0.059, p = 0.014) increases the likelihood of AF recurrence after PVI by 1.32-fold (OR = 1.316 95% CI 1.053-1.645; p = 0.016 ); galectin-3 concentration level 0.77 ng/ml or more (AUC = 0.646 ± 0.060, p = 0.019) increases the risk of AF recurrence after PVI by 5.65-fold (OR = 5.65, 95% CI 1.153-27.762 ; p = 0.033). The change in TGF-b1 concentration did not affect AF recurrence. Conclusion Metabolic syndrome presence, high epicardial fat thickness and elevated level of galectin-3 serum concentration are independent predictors of ineffectiveness of radiofrequency pulmonary vein isolation in patients with paroxysmal atrial fibrillation.