title: NT-proBNP predicts maintenance of sinus rhythm after electrical cardioversion.
abstract: BACKGROUND
  Atrial fibrillation (AF) is the most common arrhythmia. NT-proBNP is a fragment of the prohormone brain natriuretic peptide. Previous studies indicate that increased levels of NT-proBNP are associated with higher recurrence rates of AF after electrical cardioversion. Our null hypothesis was that NT-proBNP does not predict recurrence of AF after restoration of sinus rhythm.
  
  
  METHODS
  We performed a hypothesis generating study within a double-blinded, placebo-controlled, randomized, prospective multicentre study of the effects of atorvastatin on recurrence of AF after electrical cardioversion. 199 patients with persistent AF and an indication for cardioversion were included in the present substudy. NT-proBNP was assessed prior to cardioversion. Cardioversion was performed according to local standard clinical practice on an elective outpatient basis. Patients were followed-up one month after cardioversion.
  
  
  RESULTS
  181 patients had a successful cardioversion and 91 of the study group remained in sinus rhythm at day 30. Recurrence of AF was observed in 108 patients at day 30. An optimal cutpoint for NT-proBNP at 500 ng/L predicted recurrence of AF after cardioversion (OR 2.94; 95% CI 1.30-6.63). In multivariate analysis adjusting for age, sex, hypertension, and treatment group strengthened the results (OR 3,56; 95% CI 1,44-8,81). When analysing the ROC curve of NT-proBNP in baseline and atrial fibrillation at day 30 the result was 0.57.
  
  
  CONCLUSIONS
  NT-proBNP levels are a predictor of recurrence of AF 30 days after cardioversion. ROC curves indicates that the practical value of NT-proBNP for the individual patient is limited.
authors.affiliation: Department of Medicine and Geriatrics, Skellefteå County Hospital, S-931 86 Skellefteå, Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Andersson
authors.affiliation: Karolinska Institutet, Department of Clinical Scienecs, Cardiology Unit, Danderyd University Hospital, Stockholm, Sweden.
authors.forename: Mårten
authors.initials: M
authors.lastname: Rosenqvist
authors.affiliation: Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden S-118 83 Stockholm, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Tornvall
authors.affiliation: Department of Medicine and Geriatrics, Skellefteå County Hospital, S-931 86 Skellefteå, Sweden.
authors.forename: Kurt
authors.initials: K
authors.lastname: Boman
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000097:blood* / Q000628:therapy*; D004311:Double-Blind Method; D004554:Electric Countershock / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011446:Prospective Studies
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain