Clinical trial NCT05794464: The SAFE Prospective Registry
Official title: Secretoneurin as a Biomarker of Atrial Fibrillation rEcurrence After Catheter Ablation/Electrical Cardioversion
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: Atrial Fibrillation, Paroxysmal or Persistent
Keywords: atrial fibrillation
secretoneurin
catheter ablation
electrical cardio version
Lead sponsor: University Hospital Ostrava
Sponsor class: OTHER
First posted: 2023-04-03
Enrollment: 60
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Intervention model description: The study subjects will be enrolled in one group.
Primary purpose: OTHER

Brief summary: Secretoneurin (SN) is a neuropeptide from the chromogranin family that influences intracellular calcium handling. SN suppresses calcium leakage from the sarcoplasmic reticulum through the ryanodine receptor. SN is a novel biomarker that has shown the potential to predict adverse arrhythmic events.

Detailed description: The aim of the study is to sample SN before and after catheter ablation (CA) for atrial fibrillation (Afib) to predict the recurrence after CA. Also, the uric acid/albumin ratio will be assessed as a marker of Afib recurrence. Since the uric acid/albumin ratio has been shown to be predictive of Afib in patients with myocardial infarction moreover incidence of atrial fibrillation is higher in patients with gout. As a side branch marker for silent brain injury, neuron-specific enolase (NSE) and protein S100B will be evaluated. NSE showed in small trials a significant increase after catheter ablation, as well as S100B. The prognostic power is not clear yet. From the systematic review, the most powerful predictors seem to be N-terminal (NT)-prohormone B-type natriuretic peptide (NT-Pro-BNP/BNP), high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6) and Carboxy-terminal telopeptide of collagen type I. Biomarkers are divided into 3 main types: congestion, inflammation, and renal function.

Patients will be enrolled before catheter ablation/electrical cardioversion for Afib after signing IS, and the blood sampling will be performed the day before and the day after catheter ablation. In the electric cardioversion arm, the blood sampling will be performed before electrical cardioversion and 2h after the cardioversion before discharge.

Patients will be followed for recurrency - all patients will have a 24-hour ECG Holter and External loop recorder (MDT) for two weeks after the three months of the blanking period. Clinical outpatient control will ensue in the 4th, eighth,12, and 24 months.

Eligibility criteria: Inclusion Criteria:

* Atrial fibrillation (Afib); (paroxysmal, persistent)
* Patients indicated for catheter ablation and/or electrical cardioversion
* Signed informed consent

Exclusion Criteria:

* Longstanding or permanent atrial fibrillation
* Severe mitral regurgitation
* Heart failure with a permanently reduced ejection fraction
* Cerebral ischaemic stroke in \< 3 months
* Severe kidney injury
* Severe renal insufficiency
* Hepatic insufficiency limiting biomarker sampling
* Myocardial infarction \< 3 months

Primary outcomes:
measure: Atrial fibrillation recurrence based on secretoneurin levels
timeFrame: 24 months
Secondary outcomes:
measure: Brain injury detection
timeFrame: 24 months
Other outcomes:
Locations:
city: Ostrava
country: Czechia
facility: University Hospital Ostrava
state: Moravian-Silesian Region
Study officials:
affiliation: University Hospital Ostrava
name: Jiří Plášek, MD,PhD,FESC
role: PRINCIPAL_INVESTIGATOR
References:
citation: Anderson ME. Will secretoneurin be the next big thing? J Am Coll Cardiol. 2015 Feb 3;65(4):352-354. doi: 10.1016/j.jacc.2014.11.028. No abstract available.
citation: Ottesen AH, Louch WE, Carlson CR, Landsverk OJB, Kurola J, Johansen RF, Moe MK, Aronsen JM, Hoiseth AD, Jarstadmarken H, Nygard S, Bjoras M, Sjaastad I, Pettila V, Stridsberg M, Omland T, Christensen G, Rosjo H. Secretoneurin is a novel prognostic cardiovascular biomarker associated with cardiomyocyte calcium handling. J Am Coll Cardiol. 2015 Feb 3;65(4):339-351. doi: 10.1016/j.jacc.2014.10.065.
citation: Selcuk M, Cinar T, Saylik F, Akbulut T, Asal S, Cicek V, Hayiroglu MI, Tanboga IH. Predictive value of uric acid/albumin ratio for the prediction of new-onset atrial fibrillation in patients with ST-Elevation myocardial infarction. Rev Invest Clin. 2022 May 2;74(3):156-164. doi: 10.24875/RIC.22000072.
citation: Zhong X, Jiao H, Zhao D, Teng J. Serum Uric Acid Levels in Relation to Atrial Fibrillation: A Case-Control Study. Med Sci Monit. 2022 Feb 27;28:e934007. doi: 10.12659/MSM.934007.
citation: Kuo YJ, Tsai TH, Chang HP, Chua S, Chung SY, Yang CH, Lin CJ, Wu CJ, Hang CL. The risk of atrial fibrillation in patients with gout: a nationwide population-based study. Sci Rep. 2016 Sep 7;6:32220. doi: 10.1038/srep32220.
citation: Acibuca A, Vurgun VK, Gerede DM, Altin AT, Gul IS, Candemir B, Isikay Togay C, Kilickap M, Akyurek O. Serum neuron-specific enolase, a marker of neuronal injury, increases after catheter ablation of atrial fibrillation. J Int Med Res. 2018 Nov;46(11):4518-4526. doi: 10.1177/0300060518767768. Epub 2018 Sep 5.
citation: Boyalla V, Harling L, Snell A, Kralj-Hans I, Barradas-Pires A, Haldar S, Khan HR, Cleland JGF, Athanasiou T, Harding SE, Wong T. Biomarkers as predictors of recurrence of atrial fibrillation post ablation: an updated and expanded systematic review and meta-analysis. Clin Res Cardiol. 2022 Jun;111(6):680-691. doi: 10.1007/s00392-021-01978-w. Epub 2022 Jan 9.