| Backgrounds and ObjectiveAF is the most common cardiac arrhythmia encountered in clinical practice, whose prevalence is increasing and it results in a series of severe public health problems. RFCA has emerged as a curative therapeutic method for AF, but it still has a substantial recurrence rate. Currently, numerous diagnostic techniques have been identified to be helpful in predicting AF recurrence, covering blood or urine detection, echocardiography, computed tomography, magnetic resonance imaging (MRI) and electrophysiological examination; among which, detection of blood is quite cost-effective, convenient and widely accepted in daily workup. The predictive role of pre-ablation blood markers has been proved by accumulated evidences, but the conclusions remain inconsistent. Therefore we conducted a comprehensive and systematic meta-analysis to investigate candidate blood markers whose pre-ablation level was associated with atrial fibrillation (AF) recurrence after radiofrequency catheter ablation (RFCA), and providing valuable information for clinical assessment of AF recurrence.MethodsA systematic literature search of PubMed, EMBASE, Springer Link, Web of Science, Wiley-Cochrane library was performed, using following search items:"blood marker", "atrial fibrillation", "catheter ablation" and "recurrence". Revman5.3 software was applied to analysis the included literatures. Standardized mean difference (SMD) was used to present the pooled effect with 95% confidence interval.Results36 studies covering 11 blood markers were qualified for this meta-analysis, covering 11 blood markers:natriuretic peptides (NPs) (ANP, BNP and NT-pro-BNP), inflammation factors (CRP, IL-6, white blood cell (WBC)), blood lipid (T-Cho, TG and LDL), atrial fibrosis marker (TGF-β1), extracellular matrix (ECM) turnover marker (TIMP-2). Compared with the nonrecurrence group, the recurrence group had increased pre-ablation level of atrial natriuretic peptide(ANP), brain natriuretic peptide (BNP), N-terminal pro-brain natriuretic peptide (NT-pro-BNP), interleukin-6 (IL-6), C-reactive protein (CRP), low density lipoprotein (LDL), tissue inhibitor of metal loproteinase-2 (TIMP-2) (SMD [95% CI]:0.37 [0.13-0.61], 0.77 [0.40-1.14],1.25 [0.64-1.87],0.37 [0.21-0.52],0.35 [0.10-0.60],0.24 [0.07-0.42], 0.17 [0.00-0.34], respectively), while no statistical difference of pre-ablation level of white blood cell (WBC), total cholesterol (T-Cho), triglyceride (TG), transforming growth factor-(31 (TGF-γ) was found. Subgroup analysis demonstrated that in participants who had no concomitant structural heart diseases (SHD),pre-ablation ANP level was increased, however not in participants who had SHD; in Asian studies, AF recurrence participants had increased pre-ablation CRP level, whereas not in European studies.We perform subgroup analysis according to AF type, follow-up duration, concomitant structural heart diseases, geographic area and sample size, but moderate or high heterogeneity still existed among studies in BNP, NT-pro-BNP, CRP and WBC. Sensitivity analysis demonstrated that our conclusion is stable and reliable. No publication bias was present among the retrieved studies.ConclusionIncreased pre-ablation level of ANP, BNP, NT-pro-BNP, IL-6, CRP, LDL, and TIMP-2 was associated with greater risk of AF recurrence after RFCA. We found that the comorbidities of AF patients could affect the predictive role of ANP, and there are ethnic differences of CRP in predicting AF recurrence.SignificanceDetection of specific blood markers before ablation would help to stratify the AF recurrence risk might help physicians to optimize patient selection, improve treatment strategies and provide novel targets for pharmacological intervention in management of AF recurrence, further clinical studies are still needed to support the clinical application of blood markers. |
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