{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T17:18:15Z","timestamp":1785431895836,"version":"3.56.0"},"reference-count":29,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,2,27]],"date-time":"2025-02-27T00:00:00Z","timestamp":1740614400000},"content-version":"unspecified","delay-in-days":26,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2025,2,14]]},"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Pre-procedural and post-procedural plasma B-type natriuretic peptide (BNP) levels can predict rhythm outcomes after catheter ablation for atrial fibrillation (AF). However, the significance of long-term events remains unclear. Therefore, this study aimed to investigate the significance of integrating pre-ablation and post-ablation BNP levels on major adverse cardiovascular events (MACE) and arrhythmic recurrence in patients with persistent AF undergoing catheter ablation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We analysed 392 patients who underwent first catheter ablation. Patients were stratified into four subgroups based on pre-ablation plasma BNP level and its relative change after ablation (\u0394BNP) using their respective median values (pre-ablation BNP: 148.0\u2009pg\/mL, \u0394BNP: \u221252.6%): Low-Low (pre-ablation&lt;148.0\u2009pg\/mL, \u0394BNP&lt;\u221252.6%), Low-High (pre-ablation&lt;148.0\u2009pg\/mL, \u0394BNP\u2265\u221252.6%), High-Low (pre-ablation\u2265148.0\u2009pg\/mL, \u0394BNP&lt;\u221252.6%) and High-High (pre-ablation\u2265148.0\u2009pg\/mL, \u0394BNP\u2265\u221252.6%). The primary endpoint was MACE, which included all-cause death, heart failure hospitalisation and other cardiovascular hospitalisations. The secondary endpoint involved arrhythmic recurrence.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of the 392 patients, 101 were classified as Low-Low, 91 as Low-High, 97 as High-Low and 103 as High-High. During a median follow-up of 5.3 (IQR: 3.2\u20137.2) years, 63 patients (16%) experienced MACE. Heart failure hospitalisation accounted for the majority of events (63%). The High-High subgroup showed significantly higher MACE rates than others (cumulative incidence (95% CI): 26.3% (16.2% to 35.2%), p&lt;0.001). Low-High and High-High subgroups demonstrated a higher arrhythmic recurrence (p&lt;0.001). After multivariate adjustment, the High-Low and High-High subgroups demonstrated progressively higher risks of MACE incidence compared with the Low-Low and Low-High subgroups. Both Low-High and High-High subgroups showed an elevated arrhythmic recurrence risk (both p&lt;0.001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Integrating pre-ablation and post-ablation BNP levels can be useful for identifying patients with persistent AF at high risk of MACE and arrhythmic recurrence during long-term follow-up.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/openhrt-2025-003251","type":"journal-article","created":{"date-parts":[[2025,2,27]],"date-time":"2025-02-27T23:30:21Z","timestamp":1740699021000},"page":"e003251","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Integrating pre-ablation and post-ablation B-type natriuretic peptide to identify high-risk population for long-term adverse events and arrhythmic recurrence in persistent atrial fibrillation"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4597-7862","authenticated-orcid":false,"given":"Hironori","family":"Ishiguchi","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuhiro","family":"Yoshiga","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masakazu","family":"Fukuda","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shohei","family":"Fujii","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiro","family":"Hisaoka","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shintaro","family":"Hashimoto","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takuya","family":"Omuro","sequence":"additional","affiliation":[{"name":"Department of Medicine and Clinical Science, Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noriko","family":"Fukue","sequence":"additional","affiliation":[{"name":"Yamaguchi University Wellness Science Center, Yamaguchi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shigeki","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Department of Therapeutic Science for Heart Failure in the Elderly, Yamaguchi University School of Medicine, Ube, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Motoaki","family":"Sano","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,2,27]]},"reference":[{"key":"2025081710125613000_12.1.e003251.1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.122.057444"},{"key":"2025081710125613000_12.1.e003251.2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa612"},{"key":"2025081710125613000_12.1.e003251.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.hlc.2023.02.009"},{"key":"2025081710125613000_12.1.e003251.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.09.944"},{"key":"2025081710125613000_12.1.e003251.5","doi-asserted-by":"crossref","DOI":"10.3389\/fcvm.2023.1103567","article-title":"Catheter ablation vs. drug therapy in the treatment of atrial fibrillation patients with heart failure: An update meta-analysis for randomized controlled trials","volume":"10","author":"Lin","year":"2023","journal-title":"Front Cardiovasc 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Residual Risks of Thrombotic Complications in Anticoagulated Patients with Atrial Fibrillation: A Cluster Analysis Approach from the GLORIA-AF Registry. 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