title: Plasma biomarkers as predictors of recurrence of atrial fibrillation.
abstract: BACKGROUND
  Atrial fibrillation (AF) is the most common arrhythmia in the general population. There are numerous factors associated with the incidence and relapse of AF. It seems that some of them, such as neurohumoral changes, may affect AF-related atrial structural remodeling and lead to recurrence of AF.
  
  
  OBJECTIVE
  The study aimed to assess the predictive value of plasma brain natriuretic peptide (BNP), atrial natriuretic peptide (ANP), aldosterone (ALD), and endothelin 1 (ET-1) concentrations before and after electrical cardioversion (CV).
  
  
  METHODS
  The study included 60 patients with a dual-chamber pacemaker, persistent AF, and preserved left ventricular function who underwent successful CV. Blood samples were collected before and 24 hours and 7 days after CV. Recurrence of AF was identified by pacemaker logs lasting 30 minutes or longer.
  
  
  RESULTS
  During a 12-month follow-up, only 5 patients (8%) had no recurrence of AF. Before cardioversion, ANP, ALD, and ET-1 levels were the same as those observed in the control group. BNP levels were significantly elevated and the level of 1237 fmol/ml or higher differentiated between patients with and without the recurrence of AF (sensitivity, 68%; specificity, 67%). Sinus rhythm restoration resulted in a significant decrease only in the BNP level. The BNP level of 700 fmol/ml or higher on day 7 after cardioversion was the most predictive for AF recurrence (sensitivity, 78%; specificity, 71%). In a multivariate analysis, only BNP levels of 700 fmol/ml or higher on day 7 after cardioversion (P = 0.04) and lack of amiodarone (P = 0.03) were independent predictors of AF recurrence.
  
  
  CONCLUSIONS
  A BNP level of 700 fmol/ml or higher 7 days after cardioversion is an independent predictor of AF recurrence during 12 months after cardioversion. ANP, ALD, and ET-1 levels at baseline or 7 days after cardioversion are not predictive of AF recurrence.
authors.forename: Ewa
authors.initials: E
authors.lastname: Lewicka
authors.forename: Julita
authors.initials: J
authors.lastname: Dudzińska-Gehrmann
authors.forename: Alicja
authors.initials: A
authors.lastname: Dąbrowska-Kugacka
authors.forename: Paweł
authors.initials: P
authors.lastname: Zagożdżon
authors.forename: Emilia
authors.initials: E
authors.lastname: Stepnowska
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Liżewska
authors.forename: Dariusz
authors.initials: D
authors.lastname: Kozłowski
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Raczak
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000450:Aldosterone / Q000097:blood*; D001281:Atrial Fibrillation / Q000097:blood / Q000473:pathology* / Q000628:therapy; D009320:Atrial Natriuretic Factor / Q000097:blood*; D004554:Electric Countershock; D019332:Endothelin-1 / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011379:Prognosis; D012008:Recurrence; D012680:Sensitivity and Specificity
chemical_list: D019332:Endothelin-1; D020097:Natriuretic Peptide, Brain; D000450:Aldosterone; D009320:Atrial Natriuretic Factor