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Biomarkers could predict patients return to usual heart rhythm after atrial fibrillation

Blood test could help clinicians identify patients at greater risk of cardiovascular disease

2 September 2024
Print out of an EEG test

A test for three biomarkers found in blood could help clinicians predict the likelihood that patients who experience atrial fibrillation (AF), a common heart arrhythmia, are likely to return to a usual heart unaided.

The findings have been presented at the annual congress of the European Society of Cardiology (ESC) in London and published in the European Heart Journal.

The EAST – AFNET 4 (Early Treatment of Atrial Fibrillation for Stroke Prevention) trial demonstrated that early rhythm control – with antiarrhythmic drugs or atrial fibrillation ablation – delivered within one year after AF diagnosis improves outcomes in 2789 patients with early AF and cardiovascular risk factors compared to usual care (UC) over a 5-year follow-up time.

Now, a study as part of the EAST – AFNET 4 trial found that biomolecule concentrations in the blood of patients with AF can be used to identify patients at high and low cardiovascular risk.

14 biomarkers reflecting AF-related cardiovascular disease processes were quantified in the blood of 1586 participants of the EAST – AFNET 4 biomolecule study. Three of these biomarkers – ANGPT2, BMP10, and NT-proBNP – proved to be linked to a return to usual heart rhythm, known as sinus rhythm.

Higher baseline concentrations of these biomarkers were independently associated with a lower chance of sinus rhythm at 12-months, and low concentrations of ANGPT2, BMP10 and NT-proBNP predict sinus rhythm during follow-up. The predictive effect of NT-proBNP was reduced in patients receiving early rhythm control therapy, and analysis of heart rhythm at 24 months and external validation confirmed the results.

Our findings suggest that the three biomarkers .... identify patients with AF at high risk of not attaining sinus rhythm in the future.

Professor Larissa Fabritz

Professor Larissa Fabritz, Chair of Inherited Cardiac Conditions, University Center of Cardiovascular Science and Honorary Chair, Institute of Cardiovascular Sciences, University of Birmingham said:

“Our findings suggest that the three biomarkers NT-proBNP, ANGPT2 and BMP10 identify patients with AF at high risk of not attaining sinus rhythm in the future. The disease processes related to the novel biomarkers ANGPT2 and BMP10 likely also contribute to future sinus rhythm with and without rhythm control therapy. NT-proBNP elevations interact with early rhythm control, potentially suggesting repeat assessment of NT-proBNP to monitor the effectiveness of rhythm control.”

Professor Paulus Kirchhof, Hamburg, principal investigator of EAST – AFNET 4 and AFNET board chair, said:

“Predicting the chance of attaining sinus rhythm could help to identify patients requiring intensive rhythm control. The cardiovascular complication-reducing effect of early rhythm control therapy shown in the EAST – AFNET 4 study is mainly mediated by sinus rhythm at 12-month follow-up. In this analysis, we wanted to assess which biomarkers can be used to predict sinus rhythm at 12 months in patients with atrial fibrillation with and without early rhythm control therapy.”

Atrial Fibrillation (AF) is the most common arrhythmia in elderly people, and AF often occurs in patients with cardiovascular comorbidities. Recurrent AF is determined by interactions between cardiovascular disease processes and rhythm-control therapy.

Notes for editors

  • For media enquiries please contact Tim Mayo, Press Office, University of Birmingham, tel: +44 (0)7815 607 157.
  • The University of Birmingham is ranked amongst the world’s top 100 institutions. Its work brings people from across the world to Birmingham, including researchers, educators and more than 40,000 students from over 150 countries.
  • England’s first civic university, the University of Birmingham is proud to be rooted in of one of the most dynamic and diverse cities in the country. A member of the Russell Group and a founding member of the Universitas 21 global network of research universities, the University of Birmingham has been changing the way the world works for more than a century.
  • The University of Birmingham is a founding member of Birmingham Health Partners (BHP), a strategic alliance which transcends organisational boundaries to rapidly translate healthcare research findings into new diagnostics, drugs and devices for patients. Birmingham Health Partners is a strategic alliance between seven organisations who collaborate to bring healthcare innovations through to clinical application:
    • University of Birmingham
    • University Hospitals Birmingham NHS Foundation Trust
    • Birmingham Women's and Children's Hospitals NHS Foundation Trust
    • Aston University
    • The Royal Orthopaedic Hospital NHS Foundation Trust
    • Sandwell and West Birmingham Hospitals NHS Trust
    • West Midlands Academic Health Science Network
    • Birmingham and Solihull Mental Health NHS Foundation Trust
  • About the EAST – AFNET 4 trial

    EAST – AFNET 4 is an investigator-initiated trial (IIT) that compared two different treatment strategies in atrial fibrillation. The EAST – AFNET 4 trial tested whether an early, comprehensive rhythm control therapy can prevent adverse cardiovascular outcomes in patients with atrial fibrillation (AF) compared to usual care.

    A total of 2789 patients with early AF (diagnosed less than a year ago) and at least two cardiovascular conditions (approximating a CHA₂DS₂-VASc score >=2) were enrolled by 135 sites in 11 countries during 2011 to 2016. Patients were randomized 1:1 to early rhythm control therapy or usual care, stratified by sites. Patients in both groups received guideline-recommended treatment for underlying cardiovascular conditions, anticoagulation, and rate control.

    All patients in the early rhythm control group received antiarrhythmic drugs or catheter ablation after randomization (chosen by the local study teams). Rhythm control therapy was escalated with AF ablation and/or antiarrhythmic drugs when recurrent AF was documented clinically or by ECG, including monitoring with patient-operated ECG devices.

    Patients in the usual care group were initially managed with rate control. Rhythm control therapy was only used to improve atrial fibrillation-related symptoms despite optimal rate control, following current guidelines.

  • About the Atrial Fibrillation NETwork (AFNET)

    The Atrial Fibrillation NETwork is an interdisciplinary research network comprising scientists and physicians from hospitals and practices dedicated to improving the management of atrial fibrillation through coordinated research in Germany, Europe, and worldwide. Its main objective is to conduct high quality investigator-initiated clinical trials and registries on a national and international level as well as translational research projects. The AFNET continues the long-term activities of the network which has been funded by the German Federal Ministry of Research and Education over a decade.

    Since January 2015, specific projects and infrastructures of the AFNET are funded by the German Centre for Cardiovascular Research (DZHK), and some projects by EU research grants. AFNET has long expertise in the management of atrial fibrillation, but also provides support for work in other fields informing cardiovascular care. The results of 20 years of clinical and translational research improved the lives of patients with cardiovascular diseases and influenced treatment guidelines.

Featured staff

  • Professor Larissa Fabritz

    Honorary Professor

    Professor Larissa Fabritz, Honorary Professor at the Department of Cardiovascular Sciences, University of Birmingham.

    Phone: +44 (0)121 41 46938 (lab)
    Email: l.fabritz@bham.ac.uk

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