Mid-regional proadrenomedullin levels predict recurrence of atrial fibrillation after catheter ablation

BackgroundWe evaluated the prognostic value of mid-regional proadrenomedullin (MR-proADM) in atrial fibrillation (AF) patients undergoing radiofrequency ablation.MethodsPlasma concentrations of MR-proADM were measured at baseline and after 12 months in 87 AF patients in whom radiofrequency ablation was performed. The association between MR-proADM and AF recurrence was tested by univariable and multivariable Cox models.ResultsIn all 87 patients radiofrequency ablation was successfully performed. Of the total population 54% had paroxysmal AF. The mean left ventricular ejection fraction was 54% (minimum 25%). After 12 months of follow-up, 71% of the patients were free of AF recurrence. At baseline, mean MR-proADM in the total population was 0.72 nmol/l ± 0.22. Patients with AF recurrence had significantly higher baseline MR-proADM (0.89 nmol/l ± 0.29) as compared with patients without AF recurrence (0.65 nmol/l ± 0.14; p < 0.001). After 12 months, mean MR-proADM plasma concentration remained higher in patients with AF recurrence (0.81 nmol/l ± 0.22 as compared with patients free of AF 0.54 nmol/l ± 0.20; p < 0.001). Receiver operating characteristic (ROC) curve analysis for MR-proADM yields a specificity of 98% and a sensitivity of 64% with an optimal cut-off value of 0.82 nmol/l to predict recurrence of AF after catheter ablation. In the logistic regression analysis only MR-proADM remained independently predictive for AF recurrence.ConclusionThis is the first study revealing the association between MR-proADM elevation before ablation and poor outcomes after ablation of AF. Larger studies are needed to validate these results.