NT-ProBNP predicts rhythm stability after cardioversion of lone atrial fibrillation.
BACKGROUND
The aim of the present study was: (1) to determine the predictive value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) on the success of an elective direct-current cardioversion; and (2) to assess the ability to monitor rhythm stability after electrical cardioversion in patients with lone atrial fibrillation (AF).


RESULTS
Fifty-three patients with lone AF were provided with an Holter-ECG for a follow-up period of 4 weeks after elective cardioversion. NT-proBNP serum levels were measured before and 4 weeks after cardioversion. All patients presented with increased NT-proBNP serum levels (median 874 pg/ml, interquartile range 703-1,355) before cardioversion. Thirty patients were in sinus rhythm (SR) during follow-up. These patients showed a significant NT-proBNP-decrease (759 pg/ml, 618-1,139 to 318 pg/ml, 200-523, p<0.05). Nineteen patients experienced a relapse of AF. NT-proBNP was significantly higher prior to cardioversion in comparison to patients without relapse (p<0.05) and remained unchanged during follow-up (1,124 pg/ml, 925-1,542 vs 1,256 pg/ml, 945-1,509, p=NS). Four patients had short periods of silent AF detected by Holter ECG. These patients had a smaller decrease in NT-proBNP than patients with stable SR. The area under the curve of the receiver-operating characteristic curve was 0.8 for NT-proBNP to predict a successful cardioversion. Using an optimized cut-off level of 900 pg/ml, successful cardioversion can be predicted with high accuracy.


CONCLUSIONS
The probability of a successful cardioversion correlates inversely with NT-proBNP values. The short-term success of a cardioversion might be predicted by prior determination of NT-proBNP.
Möllmann
Helge
H
Kerckhoff-Klinik Bad Nauheim, Bad Nauheim, Germany. helge.moellmann@mpi-bn.mpg.de
Weber
Michael
M
Elsässer
Albrecht
A
Nef
Holger
H
Dill
Thorsten
T
Rixe
Johannes
J
Schmitt
Jörn
J
Sperzel
Johannes
J
Hamm
Christian W
CW
D000368:Aged; D019540:Area Under Curve; D001281:Atrial Fibrillation / Q000097:blood* / Q000000981:diagnostic imaging / Q000628:therapy*; D015415:Biomarkers / Q000097:blood*; D004452:Echocardiography; D004554:Electric Countershock; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D012008:Recurrence
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain