Advanced glycation end­products as a new predictor of long term outcome after catheter ablation of atrial fibrillation (2017)

Böhm A, Tothova L, Urban L, Slezak P, Musil P, Hlivak P, Hatala R

Introduction: Oxidative stress is an important contributor to the pathophysiology of atrial fibrillation (AF). Our aim was to study the oxidative stress biomarkers (OSB) in patients (pts) undergoing radio-frequency catheter pulmonary veins isolation (PVI) for paroxysmal AF and to assess its possible role in predicting long-term outcome.

Methods: In this prospective cohort study, we included 62 consecutive pts (mean age 55±8 years, 12 females and 50 males) with paroxysmal AF and implanted ECG loop recorders who underwent PVI. Plasmatic concentrations of advanced glycation end-products (AGEs), fructosamine, advanced oxidation protein products and thiobarbituric-acid reacting substances were measured immediately before the PVI. AF burden (defined as percentage of time spent in atrial fibrillation) was continually assessed during the follow–up period (1063±273 days).

Results: Nineteen pts were defined as optimal responders (oR) with total AF burden <0.5% after PVI. The remaining pts were defined as incomplete responders (iR) or non-responders (nR). In nR (20 pts) PVI was repeated. Using logistic regression model for OSB we found that only AGEs predicted significantly the outcome after PVI (OR: 1.4; p=0.008). After adjustment for age, sex, BMI, left atrial size and AF burden before PVI, only high levels of AGEs remained significantly associated with AF recurrence (OR: 1.3; p=0.03). We identified optimal cut-off AGEs concentration of 14 mg/l, which had 80% sensitivity and 68% specificity for predicting AF recurrence after PVI.

Conclusion: Higher AGEs concentrations before PVI predicted long term AF recurrence after the procedure in pts with paroxysmal AF and could contribute to optimal patient selection for catheter ablation.