title: Plasma levels of NT-pro-BNP in patients with atrial fibrillation before and after electrical cardioversion.
abstract: OBJECTIVE
  Plasma levels of brain natriuretic peptide (BNP) have been examined in studies on patients with persistent atrial fibrillation, both before and after electrical cardioversion. Studied patients often showed a comorbidity with congestive heart failure, which complicates interpretation of measured BNP values as a natriuretic peptide. The aim of this study was to examine plasma levels of N-terminal fragment pro-brain natriuretic peptide (NT-pro-BNP), which is the more stable but inactive cleavage product of pro-BNP in patients with atrial fibrillation, but normal left ventricular ejection fraction, before and after electrical cardioversion.
  
  
  METHODS
  NT-pro-BNP plasma levels of 34 consecutive patients were measured before, shortly after and 11 days after electrical cardioversion. All patients showed a normal ejection fraction after echocardiographic or laevocardiographic criteria.
  
  
  RESULTS
  At baseline, all patients showed elevated NT-pro-BNP compared to a healthy control group (1086 vs. 66.9 pg/ml, p<0.001). After a mean follow-up time of 11 days in patients with persistent restored sinusrhythm, NT-pro-BNP decreased from 1071 pg/ml at baseline to 300 pg/ml (p<0.001). In contrast, patients with recurrence of atrial fibrillation showed increased levels from 1570.5 pg/ml at baseline to 1991 pg/ml (p=0.13; n.s.). Recurrence of atrial fibrillation was independent from height of NT-pro-BNP levels at baseline (p=0.23).
  
  
  CONCLUSIONS
  Atrial fibrillation in patients with a normal left ventricular ejection fraction is associated with elevated NT-pro-BNP plasma levels, which decrease when a persistent sinus-rhythm can be restored by electrical cardioversion. On the other hand, NT-pro-BNP seems to increase (n.s.) when recurrence of atrial fibrillation occurs. Finally, NT-pro-BNP is no valid predictor for long-term success of sinus-rhythm restoration by electrical cardioversion.
authors.affiliation: HELIOS-Klinikum Wuppertal, Universitätsklinikum der Universität Witten-Herdecke, Herzzentrum Kardiologie, Medizinische Klinik III, Arrenberger Str. 20, 42117, Wuppertal, Germany. dshin@wuppertal.helios-kliniken.de
authors.forename: D-I
authors.initials: DI
authors.lastname: Shin
authors.forename: K
authors.initials: K
authors.lastname: Jaekel
authors.forename: Ph
authors.initials: P
authors.lastname: Schley
authors.forename: A
authors.initials: A
authors.lastname: Sause
authors.forename: M
authors.initials: M
authors.lastname: Müller
authors.forename: R
authors.initials: R
authors.lastname: Fueth
authors.forename: T
authors.initials: T
authors.lastname: Scheffold
authors.forename: H
authors.initials: H
authors.lastname: Guelker
authors.forename: M
authors.initials: M
authors.lastname: Horlitz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000097:blood* / Q000175:diagnosis / Q000628:therapy*; D004554:Electric Countershock / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain