A Prospective Study Of Plasma High-Sensitivity C-Reactive Protein,Atrial Natriuretic Peptide And N-Terminai Pro-Plasma Brain Natriuretic Peptide Leveles After Radiofrequency Catheter Ablation In Patients With Paroxysmal Atrial Fibrillation

Objective: to investigate the change of plasma high-sensitivity C-reactive protein (hs-CRP),Atrial Natriuretic Peptide (ANP) and N-terminal Pro-Plasma brain natriuretic peptide (NT-ProBNP) concentrations in patients with paroxysmal Atrial Fibrillation(PAF) before and after pulmonary vein isolation (PVI); explore whether the cardiac endocrine pathophysiological change had the connection with the risk of Atrial Fibrillation (AF) and recurrence of AF,maintenance of sinus rhythm(SR) after Radiofrequency(RF) Catheter Ablation.Methods: Twenty consecutive patients with frequent attacks of drugrefractory paroxysmal AF undergoing pulmonary vein isolation were enrolled in this study. Control participants (n = 20),with matched age and sex, were selected from healthy units. Transthoracic and transesophageal echocardiography were performed immediately prior to ablation to estimate Left Atrial Diameter,Left ventricular diastolic and systolic dimensions,left ventricular ejection fraction,interventricular septal thickness and to examine the presence of thrombi. At the end of follow-up, Transthoracic echocardiography were performed routinely to examine whether change of these echocardiographic parameters. Before the PVI procedure, 24 hours(hs) and 3 months after successful PVI, 3ml blood samples were obtained. The Plasma ANP,NT-ProBNP and hs-CRP concentrations, were measured separately by electrochemiluminescence immunoassay ( ECLI ) , radioimmunoassays(RIAs) and immunoturbidimetric assay.Results:⑴Compared with control subjects, median levels of NT-ProBNP of the baseline,24 hs and 3 months after the PVI procedure were significantly elevated in subjects with PAF ( ( 240.67±217.9,407.61±300.83 and 194.34±224.37 vs. 72.6±83.1pg/ml, p≤0.05); On the contrary, the levels of ANP of the baseline,24 hs and 3 months after the PVI procedure, were no significant differences between subjects with PAF and control subjects(130.2±107.9,143.8±139.7 and 129.2±121.1 vs. 102.6±53.8pg/ml, p≥0.05); At the same time, median levels of hs-CRP of the baseline and 3 months after the PVI procedure were elevated in subjects with PAF as compared with control subjects (1.16±0.74 and 1.77±2.32 vs. 0.94±0.68 mg/l, p≥0.05).⑵There were no significant differences in baseline hs-CRP and ANP levels between subjects with AF and hypertension and control subjects (1.18±0.6 vs.0.94±0.68; 103.5±81.5 vs.101.6±55.6 pg/ml)and between subjects with AF and hypertension and lone AF(1.18±0.6 vs. 1.14±0.88; 103.5±81.5 vs. 148.4±121.3, p≥0.05). levels of NT-ProBNP of the baseline in subjects with AF and hypertension and lone AF were significantly higher than those of control subjects ( 230.4±238.2 and 249.1±211.4 vs. 72.6±83.1 pg/ml, p≤0.05 ) , but there were also no significant differences between subjects with AF and hypertension and lone AF.⑶The baseline levels of ANP,NT-ProBNP and hs-CRP in patients with recurrent PAF were 202.62±125.93,375.9±207.15pg/ml and 1.61±0.85mg/l respectively ,those in patients with free of recurrent PAF were 91.23±76.07,167.84±193.18 pg/ml and 0.92±0.58 mg/l respectively, the plasma concentrations in the recurrent group were markedly higher than those in the non-recurrent AF group .⑷In patients with maintenance of sinus rhythm, plasma ANP﹑NT-ProBNP and hs-CRP concentrations decreased after successful PVI (77.7±64.99,90.86±73.2pg/ml and 0.83±0.58mg/l vs. 91.23±76.07,167.84±193.18pg/ml and 0.92±0.58mg/l, p≥0.05). But, in patients with recurrent PAF, plasma ANP﹑NT-ProBNP and hs-CRP concentrations increased after an unsuccessful PVI (217.37±147.97,386.51±287.10 pg/ml and 3.51±3.31mg/l vs. 202.62±125.93,375.9±207.15 pg/ml and 1.61±0.85 mg/l ,p≥0.05) ,three were no statistical significance between these two groups, p >0.05.Conclusion:⑴The discordant pattern with combination of elevated NT-ProBNP and normal ANP were observed in patients with PAF.⑵Elevated NT-ProBNP concentration may be an valuable marker for predicting the risk of AF, but ANP and hs-CRP concentration may not.⑶The baseline levels of plasma NT-ProBNP had Significant relations with recurrent AF, was a more sensitive biological marker for early predicting AF recurrence than Left Atrial Diameter .⑷There was a drop tendency in plasma ANP﹑NT-ProBNP﹑hs-CRP concentrations by successful PVI procedures; but increased after an unsuccessful initial PVI procedure.