Type III procollagen-N-peptide as a predictor of persistent atrial fibrillation recurrence after cardioversion

Fibrosis and inflammation may play a significant role in the pathogenesis of atrial fibrillation (AF) recurrence. Type III procollagen-N-peptide (PIIINP) may be related to atrial fibrosis and play a role in predicting the recurrence of AF. We investigated whether PIIINP as a fibrosis marker predicts the recurrence of AF after cardioversion. Serum PIIINP, interleukin-6, high-sensitivity C-reactive protein, brain natriuretic peptide, renin and aldosterone were measured at baseline and 24 months in 88 patients (62) with sinus rhythm (SR) maintenance and 54 patients (38) with AF recurrence. Furthermore, the root mean square voltage in the last 20 ms (RMS20) via P-wave signal-averaged electrocardiogram (P-SAECG) was measured and the relationship between fibrosis biomarkers and RMS20 was examined. Baseline PIIINP with AF recurrence was significantly higher than for those with SR maintenance (0.664 vs. 0.581 U/mL, P 0.001). However, there were no significant differences in other biomarkers. A logistic regression identified PIIINP (odds ratio 2.61, P 0.008) as an independent predictor of AF recurrence. The RMS20 as measured by P-SAECG with SR maintenance and PIIINP levels 0.72 U/mL (at baseline) was significantly higher after 24 months than at baseline. Furthermore, the RMS20 with AF recurrence and PIIINP levels 0.72 U/mL (at baseline) was significantly lower after 24 months than baseline. Elevated baseline PIIINP concentration is an independent predictor for AF recurrence after cardioversion. Furthermore, there is a relationship between PIIINP and RMS20 and the fibrosis of AF.