Sinus rhythm restoration after atrial fibrillation: the clinical value of N-terminal pro-BNP measurements

Vladimir Danicek, Nick Theodorovich, Shmuel Bar-Chaim, Asaf Miller, Zvi Vered, Nira Koren-Morag, Nir Uriel, Istvan Czuriga, Andrey Shopen, Nurit Brantriss, Edo Kaluski
Pacing and Clinical Electrophysiology: PACE 2008, 31 (8): 955-60

AIM: To examine the effects of sinus rhythm (SR) restoration on N-Terminal pro-BNP (NTP-BNP) in patients with atrial fibrillation (AF).

METHODS: Subjects with paroxysmal and persistent AF and absence of organic heart disease were prospectively studied. Chemical or electrical restoration of SR was attempted within 48 hours (n = 37) or >3 weeks (n = 73). Clinical and laboratory (NTP-BNP, 72-hour Holter monitor, and electrocardiogram) assessment were obtained at baseline and at 1, 30, and 180 days after SR restoration. Patients were divided into three predefined "outcome groups": (a) maintenance of SR for 1 month, (b) SR with recurrent paroxysmal AF (PaAF), and (c) early (<30 days) recurrence persistent AF (RAF).

RESULTS: Of the 110 patients enrolled, 89 had initial successful SR restoration. Baseline NTP-BNP was 936 pg/mL (interquartile range (IQR) 333-2,026); ratio between baseline and 30-day NTP-BNP was 10.2 (IQR 6.42-22.0) for SR group, 3.3 (IQR 2.45-7.34) for PaAF, and 1.07 (IQR 0.87-1.22) for RAF (P < 0.001). Patients with ratio </=3 were more likely to have PaAF (46% vs 3%, OR 30, P < 0.001).

CONCLUSION: With SR restoration, NTP-BNP decline is observed up to 1 month. NTP-BNP drop is partially or completely abolished by PaAF and RAF, respectively. NTP-BNP does not predict successful SR restoration.

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