Are the atrial natriuretic peptides a missing link predicting low-voltage areas in atrial fibrillation? Introducing the novel biomarker-based atrial fibrillation substrate prediction (ANP) score

Background In patients with atrial fibrillation (AF), left atrial (LA) enlargement, and the presence of low-voltage areas (LVAs) indicate an advanced disease stage. NT-proANP is a biomarker, which is significantly higher in both phenotypes. Prediction of LVAs before catheter ablation could impact the prognosis and therapeutical management in AF patients. Objective The aim of this study was to (a) analyze the predictive value of a novel biomarker-based AF substrate prediction score, and (b) compare it with DR-FLASH and APPLE scores. Methods Patients undergoing first AF catheter ablation were included. LA volume (LAV) was analyzed prior to ablation using cardiovascular magnetic resonance imaging (CMR). Blood plasma samples from the femoral vein were collected before AF ablation. NT-proANP was analyzed using commercially available assays. LVAs were determined using high-density maps during catheter ablation and defined as <0.5 mV. The novel ANP score (one point for Age >= 65 years, NT-proANP > 17 ng/mL, and Persistent AF) was calculated at baseline. Results The study population included 156 AF patients (64 +/- 10 years, 65% males, 61% persistent AF, 28% LVAs). The cut-off ANP score >= 2 demonstrated 77% sensitivity and 70% specificity. On logistic regression (odds ratio [OR] 3.469) and receiver operating characteristic (ROC) analysis (area under the curve [AUC] 0.778, P < .001), the ANP score significantly predicted LVAs presence. There were no differences between novel ANP score - which is a new one - is described in the ; with APPLE (AUC 0.718, P = .378) and DR-FLASH (AUC 0.766, P = .856) scores. Conclusions The novel biomarker-based ANP score demonstrates good prediction of LVAs.