The relation between oxidative stress biomarkers and atrial fibrillation after pulmonary veins isolation

Highlights

• Oxidative stress biomarkers AGEs and TBARS negatively correlate with atrial fibrillation burden after the radiofrequency catheter pulmonary veins isolation

• Oxidative stress after radiofrequency catheter isolation might play an important role in the efficacy of electrical isolation of the pulmonary veins

• Oxidative stress biomarkers might be useful in predicting atrial fibrillation after catheter ablation

Abstract

Introduction

The current paradigm claims a link between oxidative stress and atrial fibrillation. The aim of our research was to study a relation between the percentage of time spent in atrial fibrillation (AF burden) and concentrations of oxidative stress biomarkers, before and after pulmonary veins isolation (PVI).

Methodology

We included 19 patients (mean age 55 ± 10 years, 4 females and 15 males) with implanted loop recorders undergoing PVI. Plasmatic concentrations of advanced glycation end-products (AGEs), fructosamine, advanced oxidation protein products and thiobarbituric-acid reacting substances (TBARS) were measured and AF burden was recorded immediately before and 3 months after the PVI. AF burden was also recorded 9 months after the PVI.

Results

Post procedural AGEs concentration significantly negatively correlated with AF burden after 3 months (ρ = − 0.63; p < 0.01) and 9 months (ρ = − 0.5; p = 0.04), respectively as well as TBARS concentration significantly negatively correlated with AF burden after 9 months (ρ = − 0.61; p = 0.01).

Conclusion

Our study showed AGEs and TBARS to be potential predictors for AF burden after the PVI. We suppose that the more oxidative stress after the PVI is provoked, the more fibrotic tissue is produced. That means a better electrical isolation of pulmonary veins and consequently a lower AF burden.

Introduction

The current paradigm claims a strong link between inflammation and atrial fibrillation (AF). Several studies showed that prevalence and prognosis of AF are both associated with serum levels of inflammatory biomarkers such as C-reactive protein, tumor necrosis factor-α, interleukin-2, interleukin-6, and interleukin-8 [1], [2] The consequence of the inflammatory process is a production of free radicals, which in turn leads to increased oxidative stress which seems to be an important pathophysiological mechanism in the etiology and sustainability of AF. [3] Several studies showed a significant increase in oxidative damage in AF compared to sinus rhythm. Furthermore, gene expression associated with the production of reactive oxygen species was increased in AF. [4], [5], [6].

Radiofrequency catheter ablation is an effective treatment strategy for AF. [7], [8] However, it is thought that this procedure also induces inflammation with oxidative stress and potential arrhythmogenic substrates that may lead to an early or a late recurrence of arrhythmia. [9], [10].

The aim of our research was to study a relation between the oxidative stress (OS) biomarkers and AF burden, detected by an implantable loop recorder (ILR), before and after radiofrequency catheter ablation with pulmonary veins isolation (PVI).