NT-proBNP as a Predictor of Atrial Fibrillation Recurrence After Cryoballoon, Radiofrequency and Pulsed-Field
Johannes Bruss1, Thomas Kueffer1, Hildegard Tanner1
1Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Introduction:
Natriuretic peptides have shown to predict atrial fibrillation (AF) ablation success using thermal energies. Pulsed-field ablation (PFA) is a novel AF ablation technology. This study investigates the predictive value of NT-proBNP and clinical parameters for pulmonary vein isolation (PVI) success using PFA, cryoballoon ablation (CBA), and radiofrequency ablation (RFA).
Methods:
We included all patients undergoing primary PVI between May 2019 and December 2023 from our prospective registry, excluding those in randomized trials or without NT-proBNP measured ≤1 day before the procedure. Follow-up included 7-day Holter-ECGs at 3, 6, and 12 months. The primary endpoint was atrial arrhythmia recurrence between days 90-365. NT-proBNP was dichotomized using the age- and sex-adjusted 95th percentile in healthy adults.
Results:
Among 1,391 patients (median age 67 years; 29% female) undergoing primary PVI with RFA (n = 302), CBA (n = 399), or PFA (n = 690), elevated NT-proBNP levels were observed in 55%, with no significant differences between ablation modalities. NT-proBNP correlated with age and left atrial volume and was higher in patients with persistent AF. Overall, 1-year arrhythmia recurrence rate was 32.1%, without differences between ablation technologies. Elevated NT-proBNP was associated with recurrence across all subgroups. In multivariate Cox regression, NT-proBNP and persistent AF were the strongest independent predictors of recurrence. A simplified model including only NT-proBNP and AF type yielded a concordance index of 0.62.
Conclusions:
NT-proBNP is a robust predictor of atrial arrhythmia recurrence after PVI, independent of the ablation technology, and may support shared, evidence-based decision-making with patients regarding ablation success probability.
Trial Registration:
The Swiss-AF-PVI registry is registered with ClinicalTrials.gov (NCT03718364).
