title: Impact of matrix metalloproteinase-2 levels on long-term outcome following pharmacological or electrical cardioversion in patients with atrial fibrillation.
abstract: OBJECTIVE
  The aim of this study was to evaluate the role of matrix metalloproteinases (MMPs) for the prediction of long-term maintenance of sinus rhythm (SR) after cardioversion in atrial fibrillation (AF).
  
  
  RESULTS
  The study comprised 102 patients with AF. Pharmacological cardioversion was attempted for a 4-week period with anti-arrhythmic drugs in all patients. Those who failed medication underwent electrical cardioversion. Blood samples for biomarkers and echocardiographic data were obtained at baseline. Thirty-four patients (33.3%) converted to SR by pharmacological (n = 22) and electrical (n = 12) cardioversion and maintained it (SR group). The remaining 68 patients were refractory to the AF (RAF) group including recurrence (n = 22) and unsuccessful treatment (n = 46) after electrical/pharmacological cardioversion. Refractory AF was significantly associated with the duration of AF, hypertension, left atrial diameter, brain natriuretic peptide, MMP-2, and tissue inhibitor of MMP-2. For both multivariable logistic regression analysis and stepwise forward selection procedure, the duration of AF >5 months [odds ratio (OR) 15.32] and MMP-2 >767.0 ng/mL (OR 4.84) were significantly associated with RAF.
  
  
  CONCLUSIONS
  Our study suggests that elevated MMP-2 and longer AF duration increased the risk for difficulty in restoring SR in AF patients. Stratification of subjects according to the MMP-2 level may therefore be important for the effective management of AF.
authors.affiliation: Department of Cardiovascular Medicine, Gifu Prefectural Government Tajimi Hospital, 5-161 Maehata, Tajimi, Gifu 5078522, Japan. gogok@nifty.com
authors.forename: Kimihiko
authors.initials: K
authors.lastname: Kato
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Fujimaki
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Yoshida
authors.forename: Mitsutoshi
authors.initials: M
authors.lastname: Oguri
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yajima
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hibino
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Murohara
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000097:blood / Q000175:diagnosis* / Q000628:therapy*; D004554:Electric Countershock; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008137:Longitudinal Studies; D020778:Matrix Metalloproteinase 2 / Q000097:blood*; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D020778:Matrix Metalloproteinase 2