title: Elevated brain natriuretic peptide level in patients undergoing atrial fibrillation ablation: is it a predictor of failed ablation or a mere function of atrial rhythm and rate at a point in time?
abstract: BACKGROUND
  Pre- and postablation atrial fibrillation (AF) brain natriuretic peptide (BNP) levels were shown to predict increased recurrence of AF following ablation.
  
  
  OBJECTIVE
  Our objective was to assess whether elevated BNP levels merely represent the presence of AF at the time of measurement or indeed the true recurrence of AF.
  
  
  RESULTS
  In a prospective study of 88 patients undergoing AF ablation, BNP levels were measured immediately before, after, 24 h, and 4-6 months postablation. BNP levels were stratified by presenting rhythm and ventricular rate at the time of measurement. Median BNP level preablation was higher in patients presenting in AF compared to sinus rhythm (SR) (54(44-79) pg/ml vs. 30(18-47) pg/ml, p < 0.001). Postablation restoration of SR in patients presenting in AF reduced median BNP levels from 54(44-79) pg/ml to 40(37-51) pg/ml, (p < 0.001). However, no change was noted in patients who presented in and maintained SR throughout the procedure (30(18-47) pg/ml to 27(16-40) pg/ml, p = 0.270). At 4-6 months, BNP measured in patients in SR was not significantly different from postablation BNP (35(22-53) pg/ml vs. 38(20-52) pg/ml, p = 0.656), although 35% of them had AF recurrence in 1-year follow-up. Median BNP level measured in five patients while in atrial arrhythmia was elevated compared to postablation BNP (464(421-464) pg/ml to 37(36-37) pg/ml, p = 0.043). BNP levels and ventricular rates are positively correlated at all times pre- and postablation.
  
  
  CONCLUSIONS
  BNP level rises acutely during AF and with rapid ventricular rates. BNP level seems to be a function of atrial rhythm and ventricular rate rather than short- or long-term predictor of AF ablation success.
authors.affiliation: Division of Cardiology-KU Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS, 66195, USA.
authors.forename: Jayasree
authors.initials: J
authors.lastname: Pillarisetti
authors.forename: Namratha
authors.initials: N
authors.lastname: Reddy
authors.forename: Mazda
authors.initials: M
authors.lastname: Biria
authors.forename: Kay
authors.initials: K
authors.lastname: Ryschon
authors.forename: Darbhamulla
authors.initials: D
authors.lastname: Nagarajan
authors.forename: Caroline
authors.initials: C
authors.lastname: Murray
authors.forename: Donita
authors.initials: D
authors.lastname: Atkins
authors.forename: Sudharani
authors.initials: S
authors.lastname: Bommana
authors.forename: Madhu Yeruva
authors.initials: MY
authors.lastname: Reddy
authors.forename: Luigi
authors.initials: L
authors.lastname: DiBiase
authors.forename: Rhea
authors.initials: R
authors.lastname: Pimentel
authors.forename: Loren
authors.initials: L
authors.lastname: Berenbom
authors.forename: Buddhadeb
authors.initials: B
authors.lastname: Dawn
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
authors.forename: Dhanunjaya
authors.initials: D
authors.lastname: Lakkireddy
mesh_terms: D001281:Atrial Fibrillation / Q000097:blood* / Q000517:prevention & control / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D017115:Catheter Ablation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011379:Prognosis; D012008:Recurrence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain