P2643Preferential association of biomarkers with post-ablation recurrence in non-paroxysmal atrial fibrillation indicates the role of inflammation in persistence of the arrhythmia

Background: Compelling evidences suggest the association between atrial fibrillation (AF) and inflammation although it is yet to be established whether it has a causal link with the origin of AF or it is more closely related with the perpetuation of the arrhythmia. Objective: This study evaluated if baseline and post-ablation levels of inflammatory biomarkers such as matrix metalloproteinase-1 (MMP-1) and tissue inhibitor of metalloproteinase-1 (TIMP-1) impact the ablation outcome. Methods: Total 192 consecutive AF patients (age 63±6 year, 70% male, non-PAF 51%, BMI 31±6) undergoing catheter ablation were enrolled in this prospective study. Fasting blood samples collected at baseline and 24-hours post-procedure were analyzed using a quantitative immunoassay technique. Patients were followed up for 20±5 months at 3-months interval with a cardiology evaluation, 12-lead electrocardiogram and 7-day Holter monitoring. Results: Plasma levels of MMP-1 and TIMP-1 were analyzed in 192 consecutive patients undergoing catheter ablation for AF. The baseline level of MMP-1 and TIMP-1 were 14±9 ng/mL and 128±43 ng/mL respectively. At 20±5 month follow-up, 123 (64%) patients were arrhythmia-free off-antiarrhythmic drugs. Change in MMP-1 and TIMP-1 levels at 24-hr post-ablation were independently associated with the arrhythmia-recurrence on multivariate Cox analysis. Reduction in TIMP-1 (HR 0.95 [95% CI 0.90- 0.99] p=0.037) and increase in serum MMP-1 levels at 24-hour follow-up, were strongly associated with AF recurrence (HR 1.2 [95% CI 1.01–1.32], p=0.006).