Introduction
Methods
Study cohort and design
Catheter ablation protocol
Blood sample collection and processing
Clinical outcomes and follow-up
Statistical analysis
Results
Patient characteristics in patients with and without the recurrence of AF
Variable | All patients (n = 254) | Non-recurrence (n = 189) | Recurrence (n = 65) | P value |
---|---|---|---|---|
Age, years | 65.5 (9.3) | 66.0 (9.2) | 64.0 (9.4) | 0.141 |
Type of AF | 0.438 | |||
Paroxysmal AF, n (%) | 175 (68.9) | 133 (70.4) | 42 (64.6) | |
Persistent AF, n (%) | 79 (31.1) | 56 (29.6) | 23 (35.4) | |
Sex, male, n (%) | 184 (72.4) | 139 (73.5) | 45 (69.2) | 0.522 |
BMI, kg/m2 | 23.6 (3.0) | 23.5 (3.0) | 24.0 (3.2) | 0.207 |
Mean blood pressure, mmHg | 92.9 (13.0) | 92.9 (12.5) | 93.0 (14.4) | 0.948 |
Rhythm at blood sampling | 0.106 | |||
SR, n (%) | 152 (59.8) | 119 (63.0) | 33 (50.8) | |
AF, n (%) | 102 (40.2) | 70 (37.0) | 32 (49.2) | |
Current smoker, n (%) | 21 (8.3) | 16 (8.5) | 5 (7.7) | 1.000 |
CHADS2 score | 1.0 (1.0–2.0) | 1.0 (1.0–2.0) | 1.0 (1.0–2.0) | 0.170 |
CHA2DS2-VASc score | 2.0 (1.0–3.0) | 2.0 (1.0–3.0) | 2.0 (1.0–3.0) | 0.271 |
APPLE score | 1.0 (1.0–2.0) | 1.0 (1.0–2.0) | 2.0 (1.0–3.0) | 0.481 |
History of HF, n (%) | 34 (13.4) | 22 (11.6) | 12 (18.5) | 0.204 |
History of HT, n (%) | 144 (56.7) | 110 (58.2) | 34 (52.3) | 0.469 |
History of DM, n (%) | 32 (12.6) | 27 (14.3) | 5 (7.7) | 0.198 |
History of stroke/TIA, n (%) | 23 (9.1) | 19 (10.1) | 4 (6.2) | 0.456 |
History of vascular disease, n (%) | 13 (5.1) | 10 (5.3) | 3 (4.6) | 1.000 |
eGFR, mL/min/1.73 m2 | 80.4 (21.7) | 80.4 (20.9) | 80.3 (24.1) | 0.986 |
LAD, mm | 39.9 (6.8) | 39.7 (6.5) | 40.6 (7.7) | 0.357 |
LVEF, % | 62.3 (9.1) | 62.4 (9.3) | 62.0 (8.8) | 0.730 |
Medications | ||||
Type of anticoagulants | 0.273 | |||
VKA, n (%) | 48 (18.9) | 39 (20.6) | 9 (13.8) | |
DOAC, n (%) | 206 (81.1) | 150 (79.4) | 56 (86.2) | |
Acetylsalicylic acid, n (%) | 16 (6.3) | 12 (6.3) | 4 (6.2) | 1.000 |
ACEI/ARB, n (%) | 104 (40.9) | 80 (42.3) | 24 (36.9) | 0.468 |
β-blocker, n (%) | 84 (33.1) | 56 (29.6) | 28 (43.1) | 0.066 |
CCB, n (%) | 83 (32.7) | 64 (33.9) | 19 (29.2) | 0.542 |
Digitalis, n (%) | 12 (4.7) | 9 (4.8) | 3 (4.6) | 1.000 |
Loop diuretics, n (%) | 35 (13.8) | 22 (11.6) | 13 (20.0) | 0.099 |
Aldosterone antagonist, n (%) | 14 (5.5) | 9 (4.8) | 5 (7.7) | 0.358 |
Statin, n (%) | 53 (20.9) | 40 (21.2) | 13 (20.0) | 1.000 |
NCB, n (%) | 100 (39.4) | 69 (36.5) | 31 (47.7) | 0.141 |
Bepridil, n (%) | 20 (7.9) | 13 (6.9) | 7 (10.8) | 0.299 |
Amiodarone, n (%) | 11 (4.3) | 7 (3.7) | 4 (6.2) | 0.480 |
ln BNP | 4.3 (1.1) | 4.2 (1.1) | 4.6 (1.0) | 0.006 |
ln sTM | 0.95 (0.27) | 0.97 (0.28) | 0.90 (0.26) | 0.079 |
ln sELAM1 | 3.3 (0.4) | 3.3 (0.4) | 3.3 (0.5) | 0.870 |
ln sICAM1 | 5.1 (0.4) | 5.1 (0.4) | 5.2 (0.4) | 0.162 |
ln sVCAM1 | 6.7 (0.3) | 6.7 (0.3) | 6.7 (0.3) | 0.363 |
VWF activity, % | 166.3 (77.4) | 170.4 (77.2) | 154.4 (77.1) | 0.151 |
Associations of baseline variables with the recurrence of AF
Variable | Univariate | Multivariate | ||||
---|---|---|---|---|---|---|
Unadjusted HR | 95% CI | P value | Adjusted HR | 95% CI | P value | |
β-blocker (use = 1) | 1.582 | 0.968–2.585 | 0.067 | 1.345 | 0.804–2.251 | 0.258 |
Loop diuretics (use = 1) | 1.603 | 0.873–2.945 | 0.128 | not selected | ||
ln BNP (per 1 increase) | 1.353 | 1.068–1.713 | 0.012 | 1.2860 | 1.000–1.655 | 0.049 |
ln sTM (per 1 increase) | 0.447 | 0.180–1.107 | 0.082 | 0.4960 | 0.207–1.190 | 0.116 |
Correlations between ln BNP and the key risk variables
Variables | Single regression | Multiple regression | ||
---|---|---|---|---|
Unadjusted β coefficient | P value | Adjusted β coefficient | P value | |
Rhythm at blood collection (AF = 1, SR =0) | 0.857 (0.613 to 1.101) | < 0.001 | 0.482 (0.213 to 0.751) | < 0.001 |
Age (per year increase) | 0.036 (0.023 to 0.050) | < 0.001 | 0.027 (0.015 to 0.040) | < 0.001 |
Sex (male = 1, female = 0) | − 0.284 (− 0.574 to 0.005) | 0.054 | − 0.438 (− 0.722 to − 0.154) | 0.003 |
Type of AF (persistent AF = 1, paroxysmal AF = 0) | 0.877 (0.617to 1.137) | < 0.001 | 0.125 (− 0.180 to 0.430) | 0.420 |
BMI (per kg/m2 increase) | 0.007 (− 0.036 to 0.050) | 0.752 | − 0.035 (− 0.072 to 0.001) | 0.058 |
eGFR (per mL/min/1.73 m2 increase) | − 0.007 (− 0.013 to − 0.001) | 0.015 | − 0.004 (− 0.009 to 0.002) | 0.226 |
LAD (per mm increase) | 0.074 (0.057 to 0.091) | < 0.001 | 0.049 (0.030 to 0.068) | <0.001 |
LVEF (per % increase) | − 0.031 (− 0.045 to − 0.017) | < 0.001 | − 0.023 (− 0.035 to − 0.011) | <0.001 |
Subgroup analyses of risks of the recurrence of AF for ln BNP
Subgroup | Recurrence, n (%) | Hazard ratio (95% CI) of ln BNP | P value | P for interaction |
---|---|---|---|---|
Rhythm at blood collection | 0.449 | |||
Sinus rhythm (n = 152) | 33 (21.7%) | 1.397 (1.022–1.911) | 0.036 | |
Atrial fibrillation (n = 102) | 32 (31.4%) | 1.153 (0.737–1.806) | 0.533 | |
Age | 0.328 | |||
< 65 (n = 105) | 29 (27.6%) | 1.230 (0.872–1.734) | 0.238 | |
≥ 65 (n = 149) | 36 (24.2%) | 1.567 (1.126–2.181) | 0.008 | |
Sex | 0.791 | |||
Male (n = 184) | 45 (24.5%) | 1.372 (1.036–1.818) | 0.027 | |
Female (n = 70) | 20 (28.6%) | 1.270 (0.806–2.000) | 0.303 | |
Type of AF | 0.666 | |||
Paroxysmal AF (n = 175) | 42 (24.0%) | 1.415 (1.076–1.861) | 0.013 | |
Persistent AF (n = 79) | 23 (29.1%) | 1.271 (0.710–2.275) | 0.419 | |
BMI | 0.128 | |||
< 25 kg/m2 (n = 172) | 40 (23.3%) | 1.204 (0.902–1.606) | 0.207 | |
≥ 25 kg/m2 (n = 82) | 25 (30.5%) | 1.821 (1.143–2.898) | 0.012 | |
eGFR | 0.375 | |||
≥ 60 ml/min/1.78 m2 (n = 216) | 55 (25.5%) | 1.297 (0.999–1.684) | 0.051 | |
< 60 ml/min/1.78 m2 (n = 38) | 10 (26.3%) | 1.790 (0.951–1.684) | 0.071 | |
LAD | 0.443 | |||
< 40 mm (n = 129) | 28 (21.7%) | 1.213 (0.855–1.721) | 0.280 | |
≥ 40 mm (n = 125) | 37 (29.6%) | 1.467 (1.029–2.090) | 0.034 | |
LVEF | 0.863 | |||
≥ 50% (n = 227) | 58 (25.6) | 1.398 (1.086 1.800) | 0.009 | |
< 50% (n = 27) | 7 (25.9) | 1.294 (0.431 3.880) | 0.646 | |
Age and rhythm at blood collection | 0.583 | |||
Age < 65 with SR (n = 61) | 16 (26.2%) | 1.228 (0.815–1.851) | 0.326 | |
Age < 65 with AF (n = 44) | 13 (29.5%) | 1.341 (0.538–3.342) | 0.529 | |
Age ≥ 65 with SR (n = 91) | 17 (18.7%) | 1.867 (1.156–3.015) | 0.011 | |
Age ≥ 65 with AF (n = 58) | 19 (32.8) | 1.105 (0.635–1.922) | 0.724 | |
Sex and rhythm at blood collection | 0.011 | |||
Male with SR (n = 104) | 25 (24.0%) | 1.536 (1.095–2.154) | 0.013 | |
Male with AF (n = 80) | 20 (25.0%) | 1.221 (0.671–2.223) | 0.513 | |
Female with SR (n = 48) | 8 (16.7%) | 0.999 (0.432–2.311) | 0.999 | |
Female with AF (n = 22) | 12 (54.5%) | 0.743 (0.330–1.675) | 0.474 | |
Type of AF and rhythm at blood collection | 0.436 | |||
Paroxysmal AF with SR (n = 141) | 30 (21.3%) | 1.391 (0.997–1.943) | 0.052 | |
Paroxysmal AF with AF (n = 34) | 12 (35.3) | 1.162 (0.641–2.108) | 0.621 | |
Persistent AF with SR (n = 11) | 3 (27.3%) | 1.920 (0.353–10.430) | 0.450 | |
Persistent AF with AF (n = 68) | 20 (29.4%) | 1.187 (0.628–2.244) | 0.597 | |
BMI and rhythm at blood collection | 0.640 | |||
BMI < 25 kg/m2 mm with SR (n = 109) | 23 (21.1%) | 1.147 (0.791–1.664) | 0.470 | |
BMI < 25 kg/m2 mm with AF (n = 63) | 17 (27.0%) | 1.225 (0.698–2.151) | 0.479 | |
BMI ≥ 25 kg/m2 mm with SR (n = 43) | 10 (23.2%) | 2.269 (1.170–4.401) | 0.015 | |
BMI ≥ 25 kg/m2 mm with AF (n = 39) | 15 (38.5%) | 1.010 (0.437–2.335) | 0.982 | |
eGFR and rhythm at blood collection | 0.472 | |||
eGFR ≥ 60 ml/min/1.78 m2 mm with SR (n = 130) | 28 (21.5%) | 1.230 (0.881–1.716) | 0.225 | |
eGFR ≥ 60 ml/min/1.78 m2 mm with AF (n = 86) | 27 (31.3%) | 1.258 (0.742–2.131) | 0.394 | |
eGFR < 60 ml/min/1.78 m2 mm with SR (n = 22) | 5 (22.7%) | 3.702 (1.135–12.080) | 0.030 | |
eGFR < 60 ml/min/1.78 m2 mm with AF (n = 16) | 5 (31.3%) | 1.000 (0.281–3.557) | 1.000 | |
LAD and rhythm at blood collection | 0.374 | |||
LAD < 40 mm with SR (n = 100) | 19 (19.0%) | 1.034 (0.684–1.562) | 0.874 | |
LAD < 40 mm with AF (n = 29) | 9 (31.0%) | 2.033 (0.599–6.904) | 0.255 | |
LAD ≥ 40 mm with SR (n = 52) | 14 (26.9%) | 2.382 (1.305–4.348) | 0.005 | |
LAD ≥ 40 mm with AF (n = 73) | 23 (31.5%) | 0.994 (0.590–1.675) | 0.981 | |
LVEF and rhythm at blood collection | 0.876 | |||
LVEF ≥ 50% mm with SR (n = 141) | 30 (21.3) | 1.394 (0.997–1.949) | 0.052 | |
LVEF ≥ 50% mm with AF (n = 86) | 28 (32.6) | 1.230 (0.765–1.977) | 0.392 | |
LVEF < 50% mm with SR (n = 11) | 3 (27.3) | 1.487 (0.353–6.257) | 0.589 | |
LVEF < 50% mm with AF (n = 16) | 4 (25.0) | 0.933 (0.137–6.338) | 0.944 |