Atrial natriuretic peptide (ANP) is specifically secreted from the atria in response to tension stress and together with vascular cell adhesion protein-1 (VCAM-1) is associated with AF progression and recurrences. Recently we demonstrated an association between NT-proANP and VCAM1 levels with AF progression phenotypes based on persistent AF and low voltage areas (LVA): paroxysmal AF with/without LVA (PAF−/PAF+), persistent AF with/without LVA (PersAF±). The aim of the current analysis was to investigate NT-proANP and VCAM1 levels in peripheral and cardiac circulation and to analyze potential association with LAA strain.

The study included 116 patients undergoing first AF catheter ablation. Left atrial appendage (LAA) was analyzed before ablation with mid-esophageal echocardiographic in 2D-speckle tracking imaging. LAA total longitudinal strain (LAA-TLS) was assessed as the absolute difference of the maximal systo-diastolic values in extracted strain-curves. Blood plasma samples from femoral vein and LA were collected before catheter ablation. NT-proANP and VCAM1 were analyzed using commercially available assays.

There were significant differences between the groups with LAA-TLS (P<0.001), cardiac NT-proANP (P=0.009), and VCAM1 (P=0.048). On univariable analysis, age, gender, PersAF, LAA-TLS, renal function, and cardiac NT-proANP and VCAM1 significantly predicted LVA. However, on multivariable analysis, age (OR 1.097, 95%CI 1.009–1.192, P=0.029), PersAF (OR 4.713, 95%CI 1.131–19.649, P=0.033), LAA-TLS (OR 0.945, 95%CI 0.898–0.995, P=0.032) and VCAM1 (OR 1.002, 95%CI 1.000–1.004, P=0.034) remained significant predictors for LVA.

Beside age and AF type, LAA-TLS and VCAM1 were significant predictors for LVA. Larger studies analyzing non-invasive predictors for electro-anatomical remodeling in AF patients are needed to prove our results.