28Left atrial voltage predicts AF recurrence after ablation, irrespective of the rhythm during mapping, while circulating biomarkers of fibrosis do not.

Background: Circulating biomarkers potentially may be used to improve patient selection for AF ablation. Low voltage areas in the LA are known to predict arrhythmia recurrence when electrophysiological mapping is performed in sinus rhythm (SR). This study tested the predictive capabilities of type III procollagen N terminal peptide (PIIINP), galectin-3 (gal-3), fibroblast growth factor 23 (FGF-23), and type I collagen C terminal telopeptide (ICTP), and whether low voltage areas in the LA predict AF recurrence irrespective of the rhythm during mapping. Methods: 92 AF ablation patients were studied. 62 patients had paroxysmal AF, 30 had persistent or long-standing persistent AF. Biomarker levels in peripheral and intra-cardiac blood were measured with ELISA. Low voltage (<0.5mV) was expressed as a proportion of the mapped LA surface area after computer 3D reconstruction and analysis of the voltage maps. The pulmonary veins, atrial appendage, and mitral valve anulus were excluded from voltage map analysis. Follow-up was one year. The primary endpoint was recurrence of atrial arrhythmia. The secondary endpoint was designed to represent current clinical practice, and was a composite of recurrence despite 2 procedures, or after one procedure if no second procedure was undertaken. a 60-day blanking period was used. Results: The biomarkers were not predictive of either endpoint. After multivariate Cox regression analysis adjusting for age, BMI, gender, LA volume/BSA, AF classification, and AF duration, high proportion of low voltage area in the LA was found to predict the primary endpoint in SR-mapping (HR 4.323,, p 0.014) and AF mapping (HR 5.195, p 0.046). This effect was also apparent for the secondary endpoint. Conclusion: The studied biomarkers do not predict arrhythmia recurrence after catheter ablation. LA voltage is an independent predictor of recurrence, whether the LA is mapped in AF or SR. This may aid decision-making regarding suitability for further procedures in individual ablation patients.