Endothelin-1 as a predictor of atrial fibrillation recurrence after pulmonary vein isolation

A considerable rate of atrial fibrillation (AF) recurrence is one of the major limitations of pulmonary vein isolation (PVI). Although endothelin-1 (ET-1) is involved in atrial remodeling, it is unknown whether plasma ET-1 level before PVI can be used as a predictive factor for AF recurrence.

The goal of this study was to clarify whether the plasma ET-1 level, before PVI, can be used as a predictive factor for AF recurrence after PVI.

Fifty-one patients without structural heart disease who underwent PVI for symptomatic and drug-refractory paroxysmal/persistent AF were included in the study. Neurohumoral factors were measured, and transthoracic echocardiography was performed before and 6 months after each PVI. Mean left atrial (LA) pressure and arterial blood pressure (BP) were evaluated just before PVI. AF recurrence was detected by 12-lead electrocardiogram (ECG), Holter ECG, and event ECG monitor recordings, 3 to 6 months after PVI.

Among plasma levels of ET-1, atrial and brain natriuretic peptides, renin, angiotensin II, and aldosterone before PVI, only ET-1 was significantly higher in the recurrence group compared with the nonrecurrence group (2.15 +/- 0.51 vs. 1.65 +/- 0.35 pg/ml, P < .001). Both mean LA pressure and diastolic BP in the recurrence group were significantly higher than in the nonrecurrence group (mean LA pressure, 10 +/- 3 vs. 8 +/- 3 mm Hg, P < .01; diastolic BP, 82 +/- 11 vs. 71 +/- 12 mm Hg, P < .01). The plasma ET-1 level and mean LA pressure were correlative. Multiple logistic regression analyses showed that higher levels of plasma ET-1 and diastolic BP were significant prognostic predictors of AF recurrence 3 to 6 months after PVI (P < .01 and P < .05, respectively).

Our findings suggest that the plasma ET-1 level before PVI could be a crucial predictor of AF recurrence 3 to 6 months after PVI.