title: Candesartan, NT-proBNP and recurrence of atrial fibrillation after electrical cardioversion.
abstract: BACKGROUND
  Some small studies have suggested that low levels of brain natriuretic peptide (BNP) measured before electrical cardioversion for atrial fibrillation (AF) may be associated with maintenance of sinus rhythm after the procedure. We hypothesized that 1) plasma levels of N-terminal fragment of proBNP (NT-proBNP) measured before cardioversion were predictive of AF recurrence, 2) treatment with candesartan would influence the levels of NT-proBNP, and 3) restoration of sinus rhythm would reduce the levels of NT-proBNP.
  
  
  METHODS
  We investigated 171 patients with persistent AF who underwent electrical cardioversion in a prospective, blinded, placebo-controlled clinical trial (Candesartan in the Prevention of Relapsing Atrial Fibrillation, CAPRAF). Plasma levels of NT-proBNP were measured at baseline and at the end of the study. Patients with congestive heart failure were excluded from the study.
  
  
  RESULTS
  Baseline NT-proBNP levels were similar in patients with unsuccessful cardioversion (n=22), patients with successful cardioversion remaining in sinus rhythm (n=40) and patients with successful cardioversion who had a relapse of AF (n=89): median (interquartile range) 73.9 pmol/L (43.2, 145.6); 88.2 pmol/L (59.2, 147.5) and 90.0 pmol/L (55.3, 138.4), respectively. Maintenance of sinus rhythm was associated with a significant reduction in NT-proBNP levels, whereas NT-proBNP levels were not affected by treatment with candesartan.
  
  
  CONCLUSIONS
  Plasma NT-proBNP concentration measured before electrical cardioversion did neither predict cardioversion success nor relapse of AF in patients without heart failure. Treatment with candesartan did not affect the levels of NT-proBNP. Maintained sinus rhythm during follow-up was associated with a significant reduction in NT-proBNP levels.
authors.affiliation: Department of Internal Medicine, Asker and Baerum Hospital, 1309 Rud, Norway. arnljot.tveit@broadpark.no
authors.forename: Arnljot
authors.initials: A
authors.lastname: Tveit
authors.forename: Ingebjørg
authors.initials: I
authors.lastname: Seljeflot
authors.forename: Irene
authors.initials: I
authors.lastname: Grundvold
authors.forename: Michael
authors.initials: M
authors.lastname: Abdelnoor
authors.forename: Harald
authors.initials: H
authors.lastname: Arnesen
authors.forename: Pal
authors.initials: P
authors.lastname: Smith
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000097:blood* / Q000517:prevention & control / Q000628:therapy*; D001562:Benzimidazoles / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D001713:Biphenyl Compounds; D004311:Double-Blind Method; D004554:Electric Countershock / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011446:Prospective Studies; D055502:Secondary Prevention; D013777:Tetrazoles / Q000627:therapeutic use*
chemical_list: D001562:Benzimidazoles; D015415:Biomarkers; D001713:Biphenyl Compounds; D010446:Peptide Fragments; D013777:Tetrazoles; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; C081643:candesartan