AIMS: 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. METHODS AND 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%. CONCLUSION: 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. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Catheter-based atrial fibrillation (AF) ablation has become an important therapeutic option in AFpatients. 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. METHODS AND 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%. CONCLUSION: 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. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Hai Deng; Ying Bai; Alena Shantsila; Laurent Fauchier; Tatjana S Potpara; Gregory Y H Lip Journal: Clin Res Cardiol Date: 2017-05-30 Impact factor: 5.460