Carbohydrate Antigen-125 is an Independent Predictor of AF Recurrence Following Radiofrequency Catheter Ablation

A study shows that augmented plasma carbohydrate antigen-125 (CA-125) CA-125 levels are linked to a higher risk of atrial fibrillation (AF), and can independently predict AF recurrence following radiofrequency catheter ablation (RFCA). The findings were published in BMC Cardiovascular Disorders.

CA-125 a glycoprotein commonly expressed in the coelomic epithelium; the protein is released into the circulation when tissues, such as the pericardium, and pleura, are stimulated by mechanical stress or inflammation.

The researchers wrote that: “In recent years, elevated CA-125 levels in cardiac diseases, such as acute and chronic HF, pericarditis, coronary atherosclerotic heart disease, and AF have been reported in many studies, and its relevance in the prognosis of these diseases has been studied. It is used in cardiac diseases primarily to monitor congestion and inflammation and has recently emerged as a potential replacement for fluid retention and inflammatory activation in acute and chronic HF. However, almost no studies have reported the relationship between CA-125 and the late recurrence of AF after RFCA.”

In this study, researchers assessed preoperative CA-125 levels in AF patients undergoing initial RFCA using multivariate-adjusted Cox models and multivariate logistic regression to discern the relationship between and predictors of CA-125 levels and AF recurrence. The study consisted of 353 patients, of which 24% had AF recurrence at the follow-up period, which was 12 months.

According to the results, patients with AF recurrence had significantly higher baseline CA-125 levels than those without AF recurrence [(18.71 ± 12.63) vs. (11.27 ± 5.40) U/mL, P < 0.001]. The investigators not that the incidence of AF recurrence across quartiles 1-4 of CA-125 was 11.5%, 13.3%, 21.6% and 50.0%, respectively (P-trend < 0.001). The adjusted hazard ratios (aHRs) for AF recurrence across quartiles 1-4 of CA-125 were 1.00 (reference), 1.085 (95% CI, 0.468-2.520), 1.866 (95% CI, 0.867-4.019), and 4.246 (95% CI, 2.113-8.533), respectively (P-trend < 0.001), the researchers further note, and they observed a similar effect was obtained when CA-125 was studied as continuous data (aHR per unit increase in LnCA-125, 3.225, 95% CI, 2.258-4.606; P < 0.001).  Overall, the analysis found that CA-125, along with high-sensitivity C-reactive protein, and left atrium anteroposterior diameter, are independent risk factors for AF recurrence.

The study did have some potential limitations. Firstly, the stud comprised of a small sample population in a single-center. Secondly, routine follow-up was performed using 12-lead ECG or 24-h Holter monitors, which as the researchers noted, are less accurate than the 7-day dynamic electrocardiogram and may lead to ascertainment bias. Finally, plasma CA-125 levels were only analyzed at baseline; meaning that the study was unable to assess the effects of changes in CA-125 levels over time or the effect of postoperative CA-125 levels.

“Elevated CA-125 levels determined prior to RFCA are related to a higher risk of AF recurrence and are an independent predictor of 12-month AF recurrence after RFCA,” the researchers concluded. “CA-125 is an important easily available and inexpensive biomarker for predicting AF recurrence.”

They added that “[patients with] increasing pre-interventional CA-125 levels must be closely followed up.”

Plasma carbohydrate antigen-125 for prediction of atrial fibrillation recurrence after radiofrequency catheter ablation https://t.co/oXpcWQ1aV4

— MyJournals (@myjournals) August 19, 2021