Plasma atrial natriuretic peptide response to direct current cardioversion of atrial fibrillation in patients with mitral stenosis.
ABSTRACT The purpose of this study was to evaluate the effect of direct current cardioversion therapy on the plasma concentration of atrial natriuretic peptide and to determine the main factors that influence the change in plasma atrial natriuretic peptide levels in patients with atrial fibrillation.
In atrial arrythmias, whether the fast atrial rate itself or the associated elevation of atrial pressure, or both, contributes to the increase in atrial natriuretic peptide is a subject of debate.
In 15 patients with mild mitral stenosis, plasma atrial natriuretic peptide levels were measured and transmitral flow pattern was obtained by continuous wave Doppler echocardiography immediately before cardioversion and at 5 min, 4 h, 24 h and 5 days after direct current cardioversion. Mean mitral pressure gradient and atrial filling fraction were calculated on the basis of transmitral flow.
In three patients who did not have a successful return to sinus rhythm, plasma atrial natriuretic peptide levels remained elevated after cardioversion. In 12 patients who maintained sinus rhythm, plasma atrial natriuretic peptide levels were significantly reduced from 79 +/- 29 to 36 +/- 11 pg/ml 4 h after cardioversion to sinus rhythm. However, the mitral pressure gradient did not change significantly during the observation period. There were progressive increases in atrial filling fraction throughout the observation period. From 4 h to 5 days after direct current cardioversion, plasma atrial natriuretic peptide levels gradually increased concomitantly with the recovery of atrial mechanical function.
The reduction of plasma atrial natriuretic peptide levels after direct current cardioversion might be due to recovery from the high rate of atrial firing and not to an alteration in the mitral pressure gradient. Direct current cardioversion itself does not seem to influence atrial natriuretic peptide secretion. The increase in atrial natriuretic peptide levels from 4 h to 5 days after cardioversion concomitantly with an increase in atrial filling fraction may be due to recovery of atrial mechanical function.
Article: The predictive value of plasma brain natriuretic peptide for the recurrence of atrial fibrillation six months after external cardioversion.[show abstract] [hide abstract]
ABSTRACT: 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. 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. 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 = or <40 mm, 41-45 mm, and = or >45 mm: 394.6 pg/ml, 206.5 pg/ml, and 198.5 pg/ml, respectively; p=0.02). In patients with persistent AF, baseline plasma BNP level and the magnitude of its decrease after successful cardioversion may predict AF recurrence.Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir 01/2008; 36(7):456-60.