The predictive value of plasma brain natriuretic peptide for the recurrence of atrial fibrillation six months after external cardioversion

OBJECTIVES
The aim of this study was to assess the predictive value of plasma brain natriuretic peptide (BNP) level for the recurrence of atrial fibrillation (AF) after successful cardioversion in patients with persistent AF.

STUDY DESIGN
The study included 58 patients (36 females, 22 males; mean age 59 years) with preserved left ventricular function, who underwent successful electrical cardioversion for persistent AF. Plasma BNP levels were measured before, 30 minutes and six months after cardioversion and electrocardiography was performed to assess AF recurrence. Echocardiography was performed in all the patients before cardioversion.

RESULTS
At six months, 38 patients (65.5%) were in sinus rhythm (SR), whereas 20 patients (34.5%) reverted to AF. The mean baseline BNP level was significantly higher than that measured 30 minutes after cardioversion (255.6±159.6 pg/ml vs 70.5±57.0 pg/ml; p=0.00006). Patients who reverted to AF had significantly higher baseline (p=0.035) and six-month (p=0.001) BNP levels. In addition, they had a significantly greater decrease in BNP levels 30 minutes after cardioversion than patients who remained in SR (-271.9±42.4 pg/ml vs -139.4±25.3 pg/ml; p=0.008). ROC analysis of this drop with the cutoff value of 200 pg/ml predicted AF recurrence at six months with 80% sensitivity and 86% specificity. There were no correlations between baseline BNP level and duration of AF. However, left atrium diameter showed a significant negative correlation with the baseline BNP level (for ≤40 mm, 41-45 mm, and ≥45 mm: 394.6 pg/ml, 206.5 pg/ml, and 198.5 pg/ml, respectively; p=0.02).

CONCLUSION
In patients with persistent AF, baseline plasma BNP level and the magnitude of its decrease after successful cardioversion may predict AF recurrence.