Myeloperoxidase (MPO) has been associated with the development of atrial fibrillation (AF), but its impact on the recurrence of AF after catheter ablation has not been explored. This study investigated the effect of plasma MPO on recurrence after catheter ablation of paroxysmal AF.
Methods and Results
Two hundred eighty-eight consecutive patients with paroxysmal AF and who underwent circumferential pulmonary vein isolation were prospectively enrolled. After a mean ± SD follow-up of 516 ± 204 (91–910) days, the recurrence rates were 16.9%, 25.7%, 29.7%, and 38.0% from the lowest MPO quartile to the highest MPO quartile, respectively (P = 0.023). After adjustment for age, sex, left atrial diameter, high-sensitivity C-reactive protein, and pulmonary vein isolation, there was an increased risk of recurrence in the subjects with the highest MPO quartile compared with those with the lowest quartile (hazard ratio, 3.18; 95% confidence interval, 2.12–5.23; P = 0.024). As a continuous variable, MPO was also an independent predictor of recurrence (hazard ratio, 2.12; 95% confidence interval, 1.71–3.27; P = 0.032).
Conclusions
Patients with high MPO levels were at an increased risk of AF recurrence after catheter ablation.
GoAS, HylekEM, PhillipsKA, . Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001; 285: 2370–2375.
2.
BenjaminEJ, WolfPA, D'AgostinoRB, . Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation. 1998; 98: 946–952.
3.
KoitabashiT, InomataT, NiwanoS, . Paroxysmal atrial fibrillation coincident with cardiac decompensation is a predictor of poor prognosis in chronic heart failure. Circ J. 2005; 69: 823–830.
4.
BoixelC, FontaineV, Rücker-MartinC, . Fibrosis of the left atria during progression of heart failure is associated with increased matrix metalloproteinases in the rat. J Am Coll Cardiol. 2003; 42: 336–344.
5.
MarínF, RoldánV, ClimentV, . Is thrombogenesis in atrial fibrillation related to matrix metalloproteinase-1 and its inhibitor, TIMP-1? Stroke. 2003; 34: 1181–1186.
6.
MukherjeeR, HerronAR, LowryAS, . Selective induction of matrix metalloproteinases and tissue inhibitor of metalloproteinases in atrial and ventricular myocardium in patients with atrial fibrillation. Am J Cardiol. 2006; 97: 532–537.
7.
NakanoY, NiidaS, DoteK, . Matrix metalloproteinase-9 contributes to human atrial remodeling during atrial fibrillation. J Am Coll Cardiol. 2004; 43: 818–825.
8.
XuJ, CuiG, EsmailianF, . Atrial extracellular matrix remodeling and the maintenance of atrial fibrillation. Circulation. 2004; 109: 363–368.
9.
GramleyF, LorenzenJ, PlisieneJ, . Decreased plasminogen activator inhibitor and tissue metalloproteinase inhibitor expression may promote increased metalloproteinase activity with increasing duration of human atrial fibrillation. J Cardiovasc Electrophysiol. 2007; 18: 1076–1082.
10.
FuX, KassimSY, ParksWC, . Hypochlorous acid oxygenates the cysteine switch domain of pro-matrilysin (MMP-7). A mechanism for matrix metalloproteinase activation and atherosclerotic plaque rupture by myeloperoxidase. J Biol Chem. 2001; 276: 41279–41287.
11.
FuX, KassimSY, ParksWC, . Hypochlorous acid generated by myeloperoxidase modifies adjacent tryptophan and glycine residues in the catalytic domain of matrix metalloproteinase-7 (matrilysin): an oxidative mechanism for restraining proteolytic activity during inflammation. J Biol Chem. 2003; 278: 28403–28409.
12.
TangRB, DongJZ, ZhaoWD, . Unconscious sedation / analgesia with propofol versus conscious sedation with fentanyl / midazolam for catheter ablation of atrial fibrillation: a prospective, randomized study. Chin Med J (Engl). 2007; 120: 2036–2038.
13.
LiuX, DongJ, MavrakisHE, . Achievement of pulmonary vein isolation in patients undergoing circumferential pulmonary vein ablation: a randomized comparison between two different isolation approaches. J Cardiovasc Electrophysiol. 2006; 17: 1263–1270.
RudolphV, AndriéRP, RudolphTK, . Myeloperoxidase acts as a profibrotic mediator of atrial fibrillation. Nat Med. 2010; 16: 470–474.
16.
FriedrichsK, BaldusS, KlinkeA.Fibrosis in atrial fibrillation-role of reactive species and MPO. Front Physiol. 2012; 3: 214.
17.
BoosCJ, AndersonRA, LipGY.Is atrial fibrillation an inflammatory disorder?Eur Heart J. 2006; 27: 136–149.
18.
MadridAH.C-reactive protein and atrial fibrillation. An old marker looking for a new target. Rev Esp Cardiol. 2006; 59: 94–98.
19.
KorantzopoulosP, KolettisTM, GalarisD, . The role of oxidative stress in the pathogenesis and perpetuation of atrial fibrillation. Int J Cardiol. 2007; 115: 135–143.
20.
FrustaciA, ChimentiC, BellocciF, . Histological substrate of atrial biopsies in patients with lone atrial fibrillation. Circulation. 1997; 96: 1180–1184.
21.
PodrezEA, SchmittD, HoffHF, . Myeloperoxidase-generated reactive nitrogen species convert LDL into an atherogenic form in vitro. J Clin Invest. 1999; 103: 1547–1560.
22.
HochholzerW, MorrowDA, GiuglianoRP.Novel biomarkers in cardiovascular disease: update 2010. Am Heart J. 2010; 160: 583–594.
23.
LauD, MollnauH, EiserichJP, . Myeloperoxidase mediates neutrophil activation by association with CD11b/CD18 integrins. Proc Natl Acad Sci U S A. 2005; 102: 431–436.
WazniO, MartinDO, MarroucheNF, . C reactive protein concentration and recurrence of atrial fibrillation after electrical cardioversion. Heart. 2005; 91: 1303–1305.
27.
MocattaTJ, PilbrowAP, CameronVA, . Plasma concentrations of myeloperoxidase predict mortality after myocardial infarction. J Am Coll Cardiol. 2007; 49: 1993–2000.
28.
FazioS, PalmieriEA, LombardiG, . Effects of thyroid hormone on the cardiovascular system. Recent Prog Horm Res. 2004; 59: 31–50.
29.
SauerWH, McKernanML, LinD, . Clinical predictors and outcomes associated with acute return of pulmonary vein conduction during pulmonary vein isolation for treatment of atrial fibrillation. Heart Rhythm. 2006; 3: 1024–1028.
30.
PapponeC, RosanioS, AugelloG, . Mortality, morbidity, and quality of life after circumferential pulmonary vein ablation for atrial fibrillation: outcomes from a controlled nonrandomized long-term study. J Am Coll Cardiol. 2003; 42: 185–197.
