title: Baseline NT-ProBNP level predicts success of cardioversion of atrial fibrillation with flecainide.
abstract: BACKGROUND
  Patients with acute-onset symptomatic atrial fibrillation (AF) can be treated with flecainide. However, flecainide may induce arrhythmias and/or exaggerate heart failure. Therefore, validated markers to predict the efficacy of flecainide and prevent adverse effects are required. We hypothesised that lower NT-proBNP plasma levels correlate with higher success rates of cardioversion with flecainide in patients with AF.
  
  
  METHODS
  In this prospective single-centre study, we included 112 subsequent patients with acute-onset (< 24 h) symptomatic AF. Patients with symptoms of heart failure and ECG signs of ischaemia were excluded. Baseline laboratory measurements, including NT-proBNP, were done. Echocardiograms were performed ~ 2 weeks after restoration of SR.
  
  
  RESULTS
  Cardioversion with flecainide was successful in 91 patients (87 %). NT-proBNP was lower in patients with successful cardioversion (P < 0.001). Logistic regression indicated NT-proBNP as an independent predictor of successful cardioversion. A cut-off NT-proBNP value of 1550 pg/ml provided optimal test accuracy to predict successful cardioversion.
  
  
  CONCLUSIONS
  In patients with < 24 h of symptomatic AF, NT-proBNP levels up to 1550 pg/ml correlate with high success rates (94 %) of cardioversion with flecainide. Conversely, NT-proBNP higher than 1550 pg/ml correlates with poor success rates (36 %). Further research is needed to validate the predictive value of NT-proBNP for successful cardioversion with flecainide.
authors.affiliation: Heart Center, Departments of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands, a.s.amin@amc.nl.
authors.forename: Ahmad Shoaib
authors.initials: AS
authors.lastname: Amin
authors.forename: René H J
authors.initials: RH
authors.lastname: Peters
authors.forename: Maaike
authors.initials: M
authors.lastname: Verstraaten
authors.forename: Arthur A M
authors.initials: AA
authors.lastname: Wilde
authors.forename: Eugène M
authors.initials: EM
authors.lastname: Buijs