Researchers have identified a combination of serum biomarkers that is independently associated with higher prevalence of atrial fibrillation, and with increased incidence and recurrence of atrial fibrillation following ablation. The findings from Susana Ravassa (University of Navarra, and Navarra Institute for Health Research, Pamplona, Spain) et al were published in the Journal of American Cardiology.
They write: “The CCL+CD+ combination of circulating biomarkers is associated with the prevalence and the incidence of atrial fibrillation in heart failure patients, suggesting that a complex type of MIF [myocardial interstitial fibrosis], characterised by both increased collagen type I cross-linking and increased collagen type I deposition, determines the risk of AF in HF patients. In addition, the CCL+CD+ combination of biomarkers is associated with larger left atrium low-voltage areas and identifies those patients who are at high risk of AF recurrence after ablation, suggesting that the same particular type of MIF … is responsible for maintaining an arrhythmogenic substrate refractory to the catheter ablation procedure in AF patients.”
In an accompanying editorial, Kevin S. Shah (Cedars-Sinai Medical Center, Los Angeles, CA, USA) et al describe it as a step towards precision medicine. However, they caution: “Although the data from Ravassa et al are encouraging, it is important to remember that it is a single-centre study. In addition, in their heart failure study, heart failure patients with either ischaemic or structural disease were excluded. Hence … this portion of their study may not reflect the breadth of patients seen in typical clinical practice. We need to move forward with a larger study to determine ease of testing and generalisability to a larger cohort/population.”
Ravassa et al. J Am Coll Cardiol 2019; 73: 1398–410.