Relationship between NT-proBNP levels and effectiveness of pulmonary vein isolation in patients undergoing ablation for atrial fibrillation

Aim:
The effectiveness of ablation for atrial fibrillation (AF) is determined by achieving pulmonary vein isolation (PVI). One predictive factor for its success could be the N-terminal prohormone of brain natriuretic peptide (NT-proBNP) level. This study aimed to determine the relationship between NT-proBNP levels and the effectiveness of PVI during ablation in patients with AF.

Material and methods:
Before the procedure, patients had their laboratory tests taken (including NT-proBNP), and both transesophageal and transthoracic echocardiography performed. PVI was achieved with either radiofrequency waves using the CARTO system or balloon cryoablation (CB).

Results:
The study covered 151 patients. Ablation was done using CARTO in 91 and CB in 60 cases. In 45 patients, the NT-proBNP level was ≤125pg/ml (N_NT-proBNP), and in 106 it was >125pg/ml (H_NT-proBNP). The procedure was fully successful in 126 patients (83,44%). The effectiveness of PVI was comparable in both CARTO and CB (respectively 80,22% vs 88,33%, p=0,19). There was a statistically significant difference in the effectiveness of PVI between N_NT-proBNP and H_NT-proBNP (93,33% vs 79,25%, p=0,034). Effectiveness of PVI was also affected by: AF type (PAF vs CAF) (90,36% vs 75%, p=0,012), presence of AF on admission (sinus rhythm vs AF) (91,25% vs 74,65%, p=0,0062), NT-proBNP (594,81±1082,90pg/ml (successful ablation) vs 748,70±588,59pg/ml (unsuccessful ablation), p=0,0016).

Conclusions:
Patients with H_NT-proBNP achieved lower effectiveness of PVI. Other possible factors of successful PVI could include AF type, presence of AF on admission, and NT-proBNP levels.