Influence of AF burden on NT-proBNP and left ventricular reverse remodeling in patients with AF and HF: catheter ablation versus pharmacological rhythm control
B K Kadyrov, B C Bazarov, B B OrazlyyevaAbstract
Background
Atrial fibrillation (AF) in patients with heart failure (HF) promotes adverse ventricular remodeling, sustained neurohormonal activation, and impaired systolic recovery. AF burden represents a quantitative measure of arrhythmic load; however, its independent impact on biomarker dynamics and reverse remodeling under different rhythm control strategies remains insufficiently defined.
Purpose
To determine whether AF burden independently predicts NT-proBNP reduction and left ventricular ejection fraction (LVEF) recovery in patients with AF and HF undergoing catheter ablation (CA) versus pharmacological rhythm control.
Methods
Seventy-three patients (32 women, 41 men; 36–76 years) with AF and HF (NYHA III–IV) receiving guideline-directed medical therapy were prospectively included. Patients underwent CA (n=35) or pharmacological rhythm control (n=38). AF burden was quantified using 24–72-hour Holter monitoring at 6 and 12 months. NT-proBNP and LVEF were assessed at baseline and 12 months. Correlation analysis and multivariable linear regression were performed to identify independent predictors of NT-proBNP reduction and LVEF improvement.
Results
At 12 months, CA achieved significantly lower AF burden (<10%) compared with pharmacological therapy (<30%) (p<0.05). NT-proBNP decreased by 41.6±6.1% in the CA group (final levels 355–470 pg/mL) versus 16.6±8.2% in the pharmacological group (750–910 pg/mL) (p<0.01). LVEF improved more substantially after CA (+42.1±2.3%) compared with pharmacological control (+23.2±4.2%) (p<0.05). AF burden correlated with NT-proBNP reduction (r=–0.52, p<0.001) and LVEF improvement (r=–0.47, p<0.01). In multivariable analysis, AF burden remained an independent predictor of NT-proBNP reduction (β=0.41, p=0.002) and LVEF improvement (β=–0.38, p=0.004), independent of age, baseline LVEF, and HF severity. Patients achieving AF burden <10% demonstrated significantly greater LV reverse remodeling.
Conclusion
AF burden independently predicts neurohormonal deactivation and systolic recovery in patients with AF and HF. Catheter ablation provides superior AF burden reduction and is associated with enhanced reverse remodeling compared with pharmacological rhythm control. AF burden may represent a mechanistically relevant and clinically actionable marker of rhythm control efficacy.