title: The impact of B-type natriuretic peptide levels on the suppression of accompanying atrial fibrillation in Wolff-Parkinson-White syndrome patients after accessory pathway ablation.
abstract: Atrial fibrillation (AF) often coexists with Wolff-Parkinson-White (WPW) syndrome. We compared the efficacy of Kent bundle ablation alone and additional AF ablation on accompanying AF, and examined which patients would still have a risk of AF after successful Kent bundle ablation.
  
  
  
  This retrospective multicenter study included 96 patients (56±15 years, 72 male) with WPW syndrome and AF undergoing Kent bundle ablation. Some patients underwent simultaneous pulmonary vein isolation (PVI) for AF. The incidence of post-procedural AF was examined.
  
  
  
  Sixty-four patients underwent only Kent bundle ablation (Kent-only group) and 32 also underwent PVI (+PVI group). There was no significant difference in the basic patient characteristics between the groups. Additional PVI did not improve the freedom from residual AF compared to Kent bundle ablation alone (p=0.53). In the Kent-only group, AF episodes remained in 25.0% during the follow-up (709 days). A univariate analysis showed that age ≥60 years, left atrial dimension ≥38mm, B-type natriuretic peptide (BNP) ≥40pg/ml, and concomitant hypertension were predictive factors for residual AF. However, in the multivariate analysis, only BNP ≥40pg/ml remained as an independent predictive factor (HR=17.1 and CI: 2.3-128.2; p=0.006).
  
  
  
  Among patients with WPW syndrome and AF, Kent bundle ablation alone may have a sufficient clinical impact of preventing recurrence of AF in select patients. Screening the BNP level would help decide the strategy to manage those patients.
authors.affiliation: Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan. Electronic address: mihoko_kawabata.cvm@tmd.ac.jp.
authors.forename: Mihoko
authors.initials: M
authors.lastname: Kawabata
authors.affiliation: Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Goya
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan.
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Takagi
authors.affiliation: Department of Cardiology, Musashino Red Cross Hospital, Tokyo, Japan.
authors.forename: Shu
authors.initials: S
authors.lastname: Yamashita
authors.affiliation: Division of Cardiology, Yokohama-City Minato Red Cross Hospital, Yokohama, Japan.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Iwai
authors.affiliation: Department of Cardiology, Saitama Red Cross Hospital, Saitama, Japan.
authors.forename: Masahito
authors.initials: M
authors.lastname: Suzuki
authors.affiliation: Department of Cardiology, Yokohama Minami Kyosai Hospital, Yokohama, Japan.
authors.forename: Tomomasa
authors.initials: T
authors.lastname: Takamiya
authors.affiliation: Department of Cardiology, Yokohama Minami Kyosai Hospital, Yokohama, Japan.
authors.forename: Tomofumi
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: Department of Cardiology, National Disaster Medical Center, Tokyo, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Hayashi
authors.affiliation: Department of Cardiology, Musashino Red Cross Hospital, Tokyo, Japan.
authors.forename: Atsuhiko
authors.initials: A
authors.lastname: Yagishita
authors.affiliation: Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Sasaki
authors.affiliation: Department of Cardiology, National Disaster Medical Center, Tokyo, Japan.
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Takahashi
authors.affiliation: Department of Cardiology, Ome Municipal General Hospital, Tokyo, Japan.
authors.forename: Yuhichi
authors.initials: Y
authors.lastname: Ono
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Hachiya
authors.affiliation: Department of Cardiology, Musashino Red Cross Hospital, Tokyo, Japan.
authors.forename: Yasuteru
authors.initials: Y
authors.lastname: Yamauchi
authors.affiliation: Department of Cardiology, Ome Municipal General Hospital, Tokyo, Japan.
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Otomo
authors.affiliation: Department of Cardiology, Saitama Red Cross Hospital, Saitama, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Nitta
authors.affiliation: Division of Cardiology, Yokohama-City Minato Red Cross Hospital, Yokohama, Japan.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Okishige
authors.affiliation: Department of Cardiology, Yokohama Minami Kyosai Hospital, Yokohama, Japan.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Nishizaki
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan.
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Iesaka
authors.affiliation: Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Isobe
authors.affiliation: Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Kenzo
authors.initials: K
authors.lastname: Hirao
mesh_terms: D058606:Accessory Atrioventricular Bundle / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000209:etiology / Q000601:surgery*; D017115:Catheter Ablation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011667:Pulmonary Veins / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies; D014927:Wolff-Parkinson-White Syndrome / Q000150:complications*; D055815:Young Adult
chemical_list: D020097:Natriuretic Peptide, Brain
keywords: Atrial fibrillation; B-type natriuretic peptide; Catheter ablation; Wolff-Parkinson-White syndrome