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40: CARDIAC HYALURONAN MAY BE ASSOCIATED WITH THE PERSISTENCE OF ATRIAL FIBRILLATION

Learning Objectives: Hyaluronan (HA), a primary component of the extracellular matrix, is associated with several cardiovascular diseases. Recent studies have shown that an excessive deposition of extracellular matrix components plays a critical role in the pathogenesis of atrial fibrillation (AF) by interrupting cardiomyocytebundle continuity, leading to local conduction disturbances and re-entrant arrhythmias. However, its precise cardiac origin and role in AF remain unclear. Methods: We investigated chamber-specific HA levels in patients with paroxysmal AF (PAF, n = 50) or persistent AF (PSAF, n = 35). Peripheral blood was drawn from the left cubital vein via a 20gauge peripheral venous catheter before radiofrequency catheter ablation. Before ablation, a luminal coronary sinus (CS) catheter was used for plasma sampling from (1) the CS and advance transseptal guiding sheaths, (2) the right ventricle and atrium before transseptal puncture, and (3) the left atrium immediately after transseptal puncture. The levels of HA, a diacron-reactive oxygen metabolite (dROM) as a marker for oxidative stress, at different cardiac sites, and peripheral brain natriuretic peptide (BNP) levels were measured. Results: HA levels in the coronary sinus (CS-HA) were significantly higher than those at other sites, in both PAF and PSAF patients, and CS-HA levels were significantly higher in PSAF patients than in PAF patients (37.1 [interquartile range, 31.2–48.3] vs. 30.6 [23.7–40.2] pg/mL, P < 0.01). CS-HA levels correlated with CS-dROM levels and peripheral BNP levels in PSAF patients (r = 0.417, P = 0.03 and r = 0.579, P < 0.001, respectively), but not in PAF patients (r = –0.115, P = 0.421 and r = 0.048, P = 0.740, respectively). Conclusions: Our data suggests that cardiac HA could either be a cause or consequence of AF. Cardiac HA levels positively correlate with cardiac oxidative stress and peripheral BNP levels in PSAF patients, although this was not the case in PAF patients. These results indicate that cardiac HA may be associated with the persistence of AF.