title: Usefulness of serum uric acid level to predict atrial fibrillation recurrence after cryoballoon-based catheter ablation.
abstract: OBJECTIVE
  Catheter-based atrial fibrillation (AF) ablation has become an important therapeutic option in AF patients. Although there has been significant improvent in procedural success, post-procedural AF recurrences are continuing to be a major clinical problem. To the best of our knowledge, the impact of pre-procedural serum uric acid (SUA) level, as a pro-oxidant and pro-inflammatory marker, on AF recurrence following cryoballoon-based AF ablation has never been studied before. The objective of this study was to establish whether there is a relationship between levels of SUA and recurrence of paroxysmal AF after catheter ablation.
  
  
  RESULTS
  A total of 363 patients (mean age 53.5 ± 11.2 years, 52.6% male) with symptomatic paroxysmal AF underwent initial cryoablation procedure. Patients were categorized into quartiles on the basis of their pre-procedural SUA assays and follow-up, and the Kaplan-Meier estimation with a log-rank test was used for the analysis of the influence of SUA on the recurrence of AF. Post-ablation blanking period was observed for 3 months. At a mean follow-up of 19.2 ± 6.1 months, 68 patients (18.7%) had developed AF recurrence. Atrial fibrillation recurrence rates from the lowest to the highest SUA quartiles were 2.9, 7.4, 11.8, and 77.9%, respectively (P < 0.001). On multivariate Cox regression analysis, pre-ablation SUA level (HR: 1.96, 95% CI: 1.49-2.59, P < 0.001), left atrial diameter (HR: 1.11, 95% CI: 1.04-1.19, P = 0.002) and early AF recurrence (HR: 4.34, 95% CI: 1.9-9.95, P = 0.001) were independent predictors of AF recurrence after cryoablation. Using a cut-off level of 6.37, the pre-ablation SUA level predicted AF recurrence during follow-up with a sensitivity of 85.7% and a specificity of 83.7%.
  
  
  CONCLUSIONS
  In this prospective study of patients with paroxysmal AF undergoing cryoablation, increased pre-ablation SUA levels were associated with a higher rate of AF recurrence. Our results support the role of a pre-ablation pro-inflammatory and pro-oxidant environment in the development of AF recurrence after ablation therapy but suggest that other factors are also important.
authors.affiliation: Türkiye Yüksek İhtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey dru_canpolat@yahoo.com.
authors.forename: Uğur
authors.initials: U
authors.lastname: Canpolat
authors.affiliation: Department of Cardiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
authors.forename: Kudret
authors.initials: K
authors.lastname: Aytemir
authors.affiliation: Department of Cardiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
authors.forename: Hikmet
authors.initials: H
authors.lastname: Yorgun
authors.affiliation: Department of Cardiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
authors.forename: Levent
authors.initials: L
authors.lastname: Şahiner
authors.affiliation: Department of Cardiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
authors.forename: Ergün Barış
authors.initials: EB
authors.lastname: Kaya
authors.affiliation: Türkiye Yüksek İhtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey.
authors.forename: Serkan
authors.initials: S
authors.lastname: Çay
authors.affiliation: Türkiye Yüksek İhtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey.
authors.forename: Serkan
authors.initials: S
authors.lastname: Topaloğlu
authors.affiliation: Türkiye Yüksek İhtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey.
authors.forename: Dursun
authors.initials: D
authors.lastname: Aras
authors.affiliation: Department of Cardiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: Oto
mesh_terms: D001281:Atrial Fibrillation / Q000097:blood / Q000175:diagnosis* / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D006328:Cardiac Catheterization / Q000379:methods*; D003452:Cryosurgery / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014527:Uric Acid / Q000097:blood*
chemical_list: D015415:Biomarkers; D014527:Uric Acid
keywords: Atrial fibrillation; Catheter ablation; Recurrence; Uric acid