Аннотация
Abstract Background Brain natriuretic peptide (BNP) is commonly used for risk assessment in atrial fibrillation (AF) and heart failure (HF), yet its levels can shift rapidly after restoration of sinus rhythm. This study examined how BNP changes before and after AF ablation relate to long-term clinical outcomes. Methods We evaluated 136 patients (mean age 58 ± 8 years; 71.3% male) with AF and HF who underwent catheter ablation. Rhythm status and percentage changes in BNP around ablation were analyzed. Results BNP increased by 29.8% in patients who were already in sinus rhythm (N = 42) but decreased by 51.5% in those presenting with AF. Patients with baseline AF were categorized into good and poor BNP-reduction groups (each N = 48). Although AF recurrence rates were similar between groups, poor BNP reduction was a strong independent predictor of adverse clinical events—including HF hospitalization, ischemic stroke, and all-cause mortality (HR 5.95; 95% CI 1.98–19.9; p = 0.001). Echocardiographic follow-up demonstrated significant LV end-diastolic diameter reduction in all groups except the poor BNP-reduction group. Conclusion In patients with AF and HF, insufficient BNP reduction after ablation independently identifies individuals at higher risk of adverse outcomes. Serial BNP assessment may help refine risk stratification following restoration of sinus rhythm.