Increased plasma homocysteine predicts arrhythmia recurrence after minimally invasive epicardial ablation for nonvalvular atrial fibrillation

Giuseppe Nasso, Raffaele Bonifazi, Vito Romano, Mario Siro Brigiani, Flavio Fiore, Francesco Bartolomucci, Mauro Lamarra, Khalil Fattouch, Giuseppe Rosano, Mario Gaudino, Roberta Spirito, Carlo Gaudio, Giuseppe Speziale

Research output: Contribution to journalArticlepeer-review


Objective: Minimally invasive epicardial ablation via right minithoracotomy is an emerging option for patients with drug-refractory nonvalvular atrial fibrillation. To guide the development of rational treatment algorithms, factors predisposing to recurrence of arrhythmia need to be quantified and eventually treated. We addressed the association of the plasma levels of homocysteine and the recurrence of atrial fibrillation after minimally invasive ablation. Methods: We obtained peripheral blood samples from 104 patients at follow-up after arrhythmia surgery; the homocysteine concentration was expressed as micromoles per liter. Prospective follow-up was conducted through electrocardiogram Holter monitoring (average 18.5 ± 5.8 months). Stratified analysis (high vs low homocysteine) was based on the cutoff value for the last quartile of homocysteine concentration (16 μmol/L). Time-to-event and diagnostic performance analyses were performed. Results: The rate of freedom from atrial fibrillation was 89.4% at the end of follow-up. Elevated circulating homocysteine level, persistent type of atrial fibrillation, and increased left atrial dimension independently predicted the recurrence of atrial fibrillation during the follow-up (adjusted Cox regression). Patients with a high homocysteine level were more likely to have atrial fibrillation recurrence (stratified Kaplan-Meier, P

Original languageEnglish
Pages (from-to)848-853
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Issue number4
Publication statusPublished - Oct 2013


  • AF
  • area under the curve
  • atrial fibrillation
  • AUC
  • ECG
  • electrocardiogram
  • Hcy
  • homocysteine
  • radiofrequency
  • receiver operating characteristic
  • RF
  • ROC
  • TIA
  • transient ischemic attack

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine


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