Predictive value of pre-procedural autoantibodies against M2-muscarinic acetylcholine receptor for recurrence of atrial fibrillation one year after radiofrequency catheter ablation

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Abstract

Background

Increasing evidences have suggested that autoantibodies against muscarinic-2 acetylcholine receptor (anti-M ₂-R) may play an important role in the development of atrial fibrillation (AF). Predictive value of pre-procedural anti-M ₂-R for the recurrence of AF after radiofrequency catheter ablation is still unclear.

Methods

Totally 76 AF patients with preserved left ventricular systolic function were prospectively enrolled and subjected to ablation after the detection of serum anti-M ₂-R by enzyme linked immunosorbent assay. These patients were given follow-up examination for one year after ablation. Risk estimation for the recurrence of AF was performed using the univariate and multivariate logistic regression.

Results

In AF group, serum anti-M ₂-R was significantly higher than that in the control group in terms of frequency (40.8% versus 11.7%; p < 0.001) and titer (1:116 versus 1:29; p < 0.001). Compared with paroxysmal AF patients, persistent AF patients had higher frequency (57.6% versus 27.9%; p = 0.009) and titer (1:132 versus 1:94; p = 0.012) for autoantibodies. During one-year follow-up examination after ablation, the recurrence of AF was observed in 25 (32.9%) patients. Multivariate analysis showed that pre-procedural serum anti-M ₂-R was an independent predictor for the recurrence of AF at the time point of 12 months after ablation (odds ratio: 4.701; 95% confidence interval: 1.590-13.894; p = 0.005).

Conclusions

In AF patients, the frequency and titer of serum anti-M ₂-R were significantly higher than those in the control group with sinus rhythm. Pre-procedural serum anti-M ₂-R was an independent predictor for the recurrence of AF one year after radiofrequency catheter ablation.

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Most cited references 16

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Fibrosis in left atrial tissue of patients with atrial fibrillation with and without underlying mitral valve disease.

G Hindricks, A Boldt, S Dhein … (2004)

To examine the hypothesis that major extracellular matrix (ECM) proteins are expressed differently in the left atrial tissue of patients in sinus rhythm (SR), lone atrial fibrillation (AF), and AF with underlying mitral valve disease (MVD). Case-control study. 118 patients with lone AF, MVD+AF, and SR. Collagen I, collagen III, and fibronectin protein expression measured by quantitative western blotting techniques and immunohistochemical methods. Protein concentrations increased in patients with AF (all forms) compared with those in SR (all forms): collagen I (1.15 (0.11) v 0.45 (0.28), respectively; p = 0.002), collagen III (0.74 (0.05) v 0.46 (0.11); p = 0.002, and fibronectin (0.88 (0.06) v 0.62 (0.13); p = 0.08). Especially, collagen I was similarly enhanced in both lone AF (1.49 (0.15) and MVD+AF (1.53 (0.16) compared with SR (0.56 (0.28); both p = 0.01). Collagen III was not significantly increased in lone AF but was significantly increased in AF combined with MVD (0.84 (0.07) both compared with SR (0.46 (0.11); p = 0.01). The concentration of fibronectin was not significantly increased in lone AF and MVD+AF (both compared with SR). Furthermore, there was a similar degree of enhanced collagen expression in paroxysmal AF and chronic AF. AF is associated with fibrosis. Forms of AF differ from each other in collagen III expression. However, there was no systematic difference in ECM expression between paroxysmal AF and chronic AF. Enhanced concentrations of ECM proteins may have a role in structural remodelling and the pathogenesis of AF as a result of separation of the cells by fibrotic depositions.

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Pre-procedural predictors of atrial fibrillation recurrence after circumferential pulmonary vein ablation.

Josep Brugada, Germán Arriagada, Francisco Mendez … (2007)

The success rate of circumferential pulmonary vein ablation (CPVA) to treat atrial fibrillation (AF) ranges from 60 to 90%, depending on the series. The objective of the study was to identify predictors of AF recurrence after a standardized CPVA procedure. A series of 148 consecutive patients undergoing CPVA for symptomatic paroxysmal (60.8%), persistent (23.6%), or permanent (15.5%) AF refractory to antiarrhythmic drugs were included in the study. CPVA with the creation of supplementary block lines along the posterior wall and mitral isthmus was performed and a minimum of 6 months follow-up completed in all patients. Structural heart disease was present in 19.6% and hypertension in 33.8% of patients. After 13.1 +/- 8.4 months follow-up, 73.6% of patients were free of AF recurrences after a mean of 1.18 +/- 0.45 procedures/patient (one procedure in 85.2%, two procedures in 14.8%, and three procedures in 2.7%). Univariable analysis showed that the risk of AF recurrence increases with age (HR 1.03; 95% CI 1.00-1.06, P = 0.031), with the presence of previous hypertension (HR 2.7; 95% CI 1.43-5.07, P = 0.002), and if AF is permanent (HR 2.23; 95% CI 1.08-4.59, P = 0.042). In addition, larger anteroposterior left atrial diameter (LAD) (HR 1.11; 95% CI 1.05-1.18, P = 0.001) and larger left ventricular end-systolic diameter (HR 1.07; 95% CI 1.00-1.15, P = 0.029) prior to the procedure were associated with AF recurrence after CPVA. Cox regression analysis showed that hypertension (OR = 2.8; 95% CI 1.5-5.4; P = 0.002) and LAD (OR = 1.1; 95% CI 1.05-1.19, P < 0.001) were independent predictors of AF recurrence. The mean predicted proportion of patients with AF recurrence after CPVA of the multivariable model showed a linear relationship with the increase in LAD prior to the procedure. The presence of hypertension further increased the mean predicted proportion of patients with AF recurrence at each LAD. Hypertension and LAD are independent pre-procedural predictors of AF recurrence after CPVA to treat AF. These data may help in patient selection for AF ablation.

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HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures and follow-up. A report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation developed in partnership with the European Heart Rhythm Association (EHRA) and the European Cardiac Arrhythmia Society (ECAS); in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), and the Society of Thoracic Surgeons (STS). Endorsed and approved by the governing bodies of the American College of Cardiology, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, and the Heart Rhythm Society.

H. Calkins, J. Brugada, D. L. Packer … (2007)

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Author and article information

Contributors

Changhong Zou

Zhiyong Zhang

Wenmin Zhao

Guang Li

Guiling Ma

Xinchun Yang

Jianjun Zhang

Lin Zhang

Journal

Journal ID (nlm-ta): J Transl Med

Journal ID (iso-abbrev): J Transl Med

Title: Journal of Translational Medicine

Publisher: BioMed Central

ISSN (Electronic): 1479-5876

Publication date Collection: 2013

Publication date (Electronic): 7 January 2013

Volume: 11

Page: 7

Affiliations

[1 ]Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gong-Ti South Road, Beijing 100020, China

Article

Publisher ID: 1479-5876-11-7

DOI: 10.1186/1479-5876-11-7

PMC ID: 3551716

PubMed ID: 23294565

SO-VID: ad033f40-021e-4aac-aa72-e4b53668ede8

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.