Radiofrequency Ablation of Atrial Fibrillation Raises Plasma Levels of Nerve Growth Factor-beta, and Is Associated with Post-Ablation Premature Ventricular Contractions

Introduction: Nerve growth factor-ß (NGF-ß) expression is increased after radiofrequency ablation (RFA) in patients with atrial fibrillation (AF), indicating cardiac nerve sprouting. We investigated relationship between NGF-ß levles before and after RFA and variables in Holter monitoring after RFA in AF patients. Methods: This study included 307 AF patients (236 men, 55.7±11.1 years, 209 paroxysmal AF) underwent RFA. Plasma levels of NGF-ß were quantified before and after RFA and Holter monitoring was performed 3 months after RFA. Continuous variables were assessed using the median value as cut-off points. Results: NGF-ß levels increased after RFA, compared to before RFA (20.98±14.24 vs. 29.57±19.47 pg/mL, p<0.001). Patients with pre-RFA NGF-ß>17.20 pg/mL had higher proportions of premature ventricular contractions (PVCs) (0.06±0.36 vs. 0.01±0.09%, p=0.038) and LF/HF ratio (1.36±0.52 vs. 1.22± 0.41, p=0.007) in Holter monitoring than those with ‘T17.20 pg/mL. In patients without increase of NGF-ß after RFA, left atrial (LA) was larger (68.3±20.2 vs. 56.9±19.0 mL, p=0.010), and LA appendage voltage (1.97±1.05 vs. 2.53± 1.50 mV, p=0.028) and LF/HF ratio (1.15±0.40 vs. 1.32±0.48, p=0.020) were lower, compared to those with increase of NGF-ß. Conclusion: Higher pre-RFA NGF-ß levels were related to high frequency of PVCs and LF/HF ratio in Holter monitoring after RFA. Lower NGF-ß levels were related with electroanatomical remodeling of LA, including larger LA and lower LA voltage.