Kriyobalon ile Paroksizmal Atriyal Fibrilasyon Ablasyonu Yapılan Hastalarda Kardiyak Otoantikorların Rekürrensi Öngörmedeki Rolü

Abstract

Catheter ablation is recommended for the treatment of patients with paroxysmal atrial fibrillation (AF) resistant to antiarrhythmic therapy. According to the literature, AF recurrs in approximately 30% of the patients with paroxysmal atrial fibrillation. The mechanisms underlying AF etiopathogenesis at molecular and cellular levels is still not completely understood. Recent evidence suggests that autoimmune antibodies also play a role in the development of AF. There are studies demonstrating the association of B1 adrenergic receptor, M2 muscarinic receptor, myosin and heat shock protein autoantibodies with atrial fibrillation development and recurrence. The objective of this study is to determine the predictive role of pre-procedural levels of B1 mimetic and M2 muscarinic receptor autoantibodies on recurrence in patients with paroxysmal atrial fibrillation after cryoablation. 80 patients (mean age 54.25±7.7; 40% males) with symptomatic paroxysmal AF in whom ablation was performed with cryoballoon were included in this study. Patients had paroxysmal AF for a median duration of 36 months and a median EHRA score of 2.5. Symptoms were present despite the use of 2 different antiarrhythmic drugs (median value). Pre-procedural levels of autoantibodies against M2 muscarinic acetylcholine (mAChRM2) receptor and beta-1 adrenergic receptor (b1AR), and clinic and echocardiographic parameters were determined in all patients. The duration and temperature of cryoballoon performed in PV’s were noted in all the patients. Transthoracic echocardiography was performed in all patients after the procedure to evaluate the presence of pericardial effusion. Major complication was not seen in any of the patients. The first three months after ablation was regarded as the blind period. 24-hour Holter vii monitorization was performed 3, 6 and 9 months after the procedure to evaluate recurrence. Patients were followed up for a mean duration of 14 months and atrial fibrillation recurrence was found in 21.25% of the patients. In the multivariate Cox regression analysis, B1 mimetic receptor autoantibody levels greater than 159.88 ng/ml (HR: 4.281, 95% CI: 1.108-18.175, p= 0.039) and M2 muscarinic receptor autoantibody levels greater than 277.65 ng/ml (HR: 4.313, 95% CI: 11.151-16.164, p= 0.030) were found to be independent predictors of recurrence. Recurrence risk was 4.281 times higher when B1 mimetic receptor autoantibody level was greater than 159.88 ng/ml and 4.313 times higher when M2 muscarinic receptor autoantibody level was greater than 277.65 ng/ml. B1 mimetic receptor autoantibody level greater than 159.88 ng/ml was found to be a risk factor for recurrence with 70.59% sensitivity and 90.48% specificity. Similarly, M2 muscarinic receptor autoantibody level greater than 277.65 ng/ml was found to be a risk factor of recurrence with a sensitivity of 70.59% and specificity of 95.24%. In conclusion, B1 mimetic and M2 muscarinic receptor autoantibody levels are associated with AF recurrence and may be useful in the selection of patients for AF ablation.