title: Biomarkers in Persistent AF and Heart Failure: Impact of Catheter Ablation Compared with Rate Control.
abstract: BACKGROUND
  To investigate the effects of catheter ablation and rate control strategies on cardiac and inflammatory biomarkers in patients with heart failure and persistent atrial fibrillation (AF).
  
  
  METHODS
  Patients were recruited from the ARC-HF trial (catheter Ablation vs Rate Control for management of persistent AF in Heart Failure, NCT00878384), which compared ablation with rate control for persistent AF in heart failure. B-type natriuretic peptide (BNP), midregional proatrial natriuretic peptide (MR-proANP), apelin, and interleukin-6 (IL-6) were assayed at baseline, 3 months, 6 months, and 12 months. The primary end point, analyzed per-protocol, was changed from baseline at 12 months.
  
  
  RESULTS
  Of 52 recruited patients, 24 ablation and 25 rate control subjects were followed to 12 months. After 1.2 ± 0.5 procedures, sinus rhythm was present in 22 (92%) ablation patients; under rate control, rate criteria were achieved in 23 (96%) of 24 patients remaining in AF. At 12 months, MR-proANP fell significantly in the ablation arm (-106.0 pmol/L, interquartile range [IQR] -228.2 to -60.6) compared with rate control (-28.7 pmol/L, IQR -69 to +9.5, P = 0.028). BNP showed a similar trend toward reduction (P = 0.051), with no significant difference in apelin (P = 0.13) or IL-6 (P = 0.68). Changes in MR-proANP and BNP correlated with peak VO2 and ejection fraction, and MR-proANP additionally with quality-of-life score.
  
  
  CONCLUSIONS
  Catheter ablation, compared with rate control, in patients with heart failure and persistent AF was associated with significant reduction in MR-proANP, which correlated with physiological and symptomatic improvement. Ablation-based rhythm control may induce beneficial cardiac remodeling, unrelated to changes in inflammatory state. This may have prognostic implications, which require confirmation by event end point studies.
authors.affiliation: Department of Cardiac Electrophysiology, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, Imperial College London, London, UK.|Department of Cardiology, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, Imperial College London, London, UK.
authors.forename: David G
authors.initials: DG
authors.lastname: Jones
authors.affiliation: Department of Cardiac Electrophysiology, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, Imperial College London, London, UK.|Department of Cardiology, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, Imperial College London, London, UK.
authors.forename: Shouvik K
authors.initials: SK
authors.lastname: Haldar
authors.affiliation: Department of Clinical Biochemistry, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, Imperial College London, London, UK.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Donovan
authors.affiliation: Department of Cardiology, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, Imperial College London, London, UK.
authors.forename: Theresa A
authors.initials: TA
authors.lastname: McDonagh
authors.affiliation: Department of Cardiology, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, Imperial College London, London, UK.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Sharma
authors.affiliation: Department of Cardiac Electrophysiology, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, Imperial College London, London, UK.|Department of Cardiology, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, Imperial College London, London, UK.
authors.forename: Wajid
authors.initials: W
authors.lastname: Hussain
authors.affiliation: Department of Cardiac Electrophysiology, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, Imperial College London, London, UK.|Department of Cardiology, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, Imperial College London, London, UK.
authors.forename: Vias
authors.initials: V
authors.lastname: Markides
authors.affiliation: Department of Cardiac Electrophysiology, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, Imperial College London, London, UK. tom.wong@imperial.ac.uk.|Department of Cardiology, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, Imperial College London, London, UK. tom.wong@imperial.ac.uk.
authors.forename: Tom
authors.initials: T
authors.lastname: Wong
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D000073861:Apelin; D001281:Atrial Fibrillation / Q000097:blood* / Q000175:diagnosis / Q000628:therapy*; D009320:Atrial Natriuretic Factor / Q000097:blood; D015415:Biomarkers / Q000097:blood*; D002304:Cardiac Pacing, Artificial; D017115:Catheter Ablation; D002908:Chronic Disease; D005260:Female; D006333:Heart Failure; D006801:Humans; D036341:Intercellular Signaling Peptides and Proteins / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D017063:Outcome Assessment, Health Care / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: C115436:APLN protein, human; D000889:Anti-Arrhythmia Agents; D000073861:Apelin; D015415:Biomarkers; C508600:IL6 protein, human; D036341:Intercellular Signaling Peptides and Proteins; D015850:Interleukin-6; C552580:midregional pro-atrial natriuretic peptide, human; D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor
keywords: atrial fibrillation; biomarkers; catheter ablation; heart failure; rate control