Elevated NT-proBNP and persistent AF independently predicted 1-year atrial arrhythmia recurrence (overall rate 32.1%) after PVI across all ablation modalities, yielding a concordance index of 0.62.
Cohort (n=1,391)
Does pre-procedural NT-proBNP predict atrial arrhythmia recurrence in patients undergoing primary PVI for atrial fibrillation?
Pre-procedural NT-proBNP is a robust, independent predictor of atrial arrhythmia recurrence after PVI, regardless of whether radiofrequency, cryoballoon, or pulsed-field ablation is used.
Introduction Natriuretic peptides have shown to predict atrial fibrillation (AF) ablation success using thermal energies. Pulsed-field ablation (PFA) is a novel AF ablation technology. This study investigates the predictive value of NT-proBNP and clinical parameters for pulmonary vein isolation (PVI) success using PFA, cryoballoon ablation (CBA), and radiofrequency ablation (RFA). Methods We included all patients undergoing primary PVI between May 2019 and December 2023 from our prospective registry, excluding those in randomized trials or without NT-proBNP measured ≤1 day before the procedure. Follow-up included 7-day Holter-ECGs at 3, 6, and 12 months. The primary endpoint was atrial arrhythmia recurrence between days 90-365. NT-proBNP was dichotomized using the age- and sex-adjusted 95th percentile in healthy adults. Results Among 1,391 patients (median age 67 years; 29% female) undergoing primary PVI with RFA (n = 302), CBA (n = 399), or PFA (n = 690), elevated NT-proBNP levels were observed in 55%, with no significant differences between ablation modalities. NT-proBNP correlated with age and left atrial volume and was higher in patients with persistent AF. Overall, 1-year arrhythmia recurrence rate was 32.1%, without differences between ablation technologies. Elevated NT-proBNP was associated with recurrence across all subgroups. In multivariate Cox regression, NT-proBNP and persistent AF were the strongest independent predictors of recurrence. A simplified model including only NT-proBNP and AF type yielded a concordance index of 0.62. Conclusions NT-proBNP is a robust predictor of atrial arrhythmia recurrence after PVI, independent of the ablation technology, and may support shared, evidence-based decision-making with patients regarding ablation success probability. Trial Registration The Swiss-AF-PVI registry is registered with ClinicalTrials.gov (NCT03718364).
Bruss et al. (Thu,) conducted a cohort in Atrial fibrillation (n=1,391). Elevated NT-proBNP vs. Normal NT-proBNP was evaluated on Atrial arrhythmia recurrence between days 90-365. Elevated NT-proBNP and persistent AF independently predicted 1-year atrial arrhythmia recurrence (overall rate 32.1%) after PVI across all ablation modalities, yielding a concordance index of 0.62.