title: Relationship between brain natriuretic peptides and recurrence of atrial fibrillation after successful direct current cardioversion: a meta-analysis.
abstract: BACKGROUND
  Atrial fibrillation (AF) recurrence is common after successful direct current cardioversion (DCCV), with a 40% rate of recurrence within the first month. Several studies have investigated the potential association between brain natriuretic peptide (BNP) or N-terminal (NT)-proBNP levels before DCCV and the risk of AF recurrence, but results have been inconsistent. We, therefore, conducted a systematic review and meta-analysis of all available data to determine whether sinus rhythm (SR) maintenance after successful DCCV may be determined by preprocedural BNP and NT-proBNP levels.
  
  
  METHODS
  We systematically searched Scopus, the Cochrane library, EMBASE, and MEDLINE databases to identify publications evaluating BNP or NT-proBNP levels in relation to post-DCCV AF recurrence, indexed from inception to September 2013. Among the initial 1,067 citations, 18 studies fulfilled the specified criteria. The difference in BNP and NT-proBNP concentrations in the AF recurrence and the SR-maintaining group was estimated by the standardized mean difference and the estimates of the pooled outcomes were evaluated using random-effects models.
  
  
  RESULTS
  Baseline BNP levels in the AF recurrence group were significantly higher compared to BNP levels in the SR-maintaining group (standardized mean difference [SMD] -1.51, confidence interval [CI] [-2.53, -0.48], P = 0.004). Similar results were observed for NT-proBNP levels, which were significantly higher in the AF recurrence group compared with the SR-maintaining group (SMD -0.63, CI [-1.13, -0.14], P = 0.01).
  
  
  CONCLUSIONS
  Our analysis suggests that low preprocedural BNP/NT-proBNP levels are associated with SR maintenance. The use of BNP or NT-proBNP for prediction of long-term response to DCCV appears to be useful and should be further evaluated.
authors.affiliation: Department of Cardiology, Athens Red Cross Hospital, Athens, Greece; Department of Cardiology, Athens Euroclinic, Athens, Greece.
authors.forename: Theodoros
authors.initials: T
authors.lastname: Zografos
authors.forename: Christos
authors.initials: C
authors.lastname: Maniotis
authors.forename: Apostolos
authors.initials: A
authors.lastname: Katsivas
authors.forename: Demosthenes
authors.initials: D
authors.lastname: Katritsis
mesh_terms: D001281:Atrial Fibrillation / Q000097:blood* / Q000628:therapy*; D004554:Electric Countershock; D006801:Humans; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D012008:Recurrence
chemical_list: D020097:Natriuretic Peptide, Brain
keywords: B-type natriuretic peptide; atrial fibrillation; direct current cardioversion