Phenotypic Analysis of Persistent Atrial Fibrillation Focusing on Postablation Prognosis Using Brain Natriuretic...

Brain natriuretic peptide (BNP) is a key predictor of clinical events after catheter ablation (CA) for atrial fibrillation (AF), but BNP levels are influenced by multiple factors. It remains unclear how these factors affect prognosis in AF patients after CA. Persistent AF (PerAF) patients undergoing initial CA were enrolled. Independent factors associated with BNP levels were identified using multivariable analysis. A total of 554 patients with high BNP (>100 pg/mL) were classified by hierarchical cluster analysis incorporating these factors. We compared baseline characteristics and the composite outcome of heart failure (HF) hospitalization and all-cause mortality among phenogroups. High BNP levels were significantly associated with increased risk of the composite endpoint after CA in PerAF patients (p <0.001). Multivariable regression analysis identified body mass index (BMI), creatinine, left ventricular (LV) ejection fraction, septal E/e', and severe tricuspid regurgitation (TR) as independent determinants of BNP levels. Hierarchical clustering analysis identified 5 phenotypes: Phenotype 1, "No risk factors for high BNP level," Phenotype 2, "LV diastolic dysfunction," Phenotype 3, "Low BMI," Phenotype 4, "LV systolic dysfunction," and Phenotype 5, "Renal dysfunction." Cox proportional hazards analysis demonstrated that Phenotype 4 and Phenotype 5 were independently associated with a higher risk of the composite endpoint compared to Phenotype 1 (hazard ratios: 3.67 and 7.44, p = 0.034 and p <0.001, respectively). In conclusion, BNP-based phenotyping identified high-risk subgroups among PerAF patients post-CA. Patients with LV systolic dysfunction or renal dysfunction exhibited the highest risk of HF hospitalization and mortality post-CA, suggesting the need for tailored postablation management strategies.