Asymmetric dimethylarginine concentration and recurrence of atrial tachyarrythmias after catheter ablation in patients with persistent atrial fibrillation

Purpose It has been reported that elevation of asymmetric dimethylarginine (ADMA) concentration is involved in atrial fibrillation (AF) process. The purpose of this study was to determine whether ADMA concentration is related to recurrences of AF after catheter ablation. Methods A total of one hundred and thirty-eight patients with persistent AF (49.91 +/- 7.23 years), but without known heart disease, who underwent successful mapping and catheter ablation were included. Serum ADMA levels were measured 1 day before the catheter ablation. Results After a mean follow-up period of 285 days (range, 98-651 days), 80 (58%) patients underwent the AF recurrence. Comparing with no AF recurrence group, the serum ADMA concentration, left atrial diameter, and persistent duration of AF in patients with AF recurrence group were significantly increased. Left atrial diameter, persistent duration of AF, and the number of non-pulmonary vein ectopy ablation were increased when serum ADMA concentration was elevated. In addition, AF recurrences were significantly increased when serum ADMA concentration was elevated. A multivariable Cox regression analysis demonstrated that the elevated ADMA concentration [hazard ration (95% CI), 4.59 (1.81-11.62); P=0.001], the left atrial diameter [1.35 (1.18-1.55), P<0.001], and the number of non-pulmonary vein ectopy ablation [1.94 (1.18-3.18), P=0.009] were independent factors associated with the AF recurrence after catheter ablation. Conclusions This study demonstrated that (1) serum ADMA concentrations were associated with non-PV ectopies and (2) increased serum ADMA concentrations were associated with higher rate of AF recurrence after catheter ablation in patients with persistent AF, supporting our hypothesis that ADMA might participate in the process of atrial remodeling.