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      Relationship between Brain Natriuretic Peptide and Recurrence of Atrial Fibrillation after Successful Electrical Cardioversion: an Updated Meta-Analysis

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          Abstract

          Objective

          To investigate the relationship between brain natriuretic peptide and recurrence of atrial fibrillation after successful electrical cardioversion.

          Methods

          Medline and Embase databases were used to identify publications evaluating BNP/N-Terminal (NT)-proBNP levels in association with atrial fibrillation recurrence after successful electrical cardioversion. Nineteen studies that fulfilled the specified criteria of our analysis were found.

          Results

          Baseline BNP/NT-proBNP levels of the atrial fibrillation recurrence group were significantly higher than those of the sinus rhythm maintaining group (SMD -0.70, CI [-0.82, -0.58]).

          Conclusion

          Our analysis suggests that low BNP/NT-proBNP levels are associated with sinus rhythm maintenance, and baseline BNP/NT-proBNP concentrations may be a predictor of atrial fibrillation recurrence after successful electrical cardioversion.

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          Most cited references30

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          Brain natriuretic peptide is elevated in outpatients with atrial fibrillation.

          Shmuel Ravid, Helme Silvet, Diana Walleigh … (2003)
          Brain natriuretic peptide (BNP) levels were measured in 72 outpatients with chronic atrial fibrillation (AF) and in 49 control patients without AF. BNP levels were significantly higher in patients with AF (median value 131 pg/ml) than without AF (median value 49 pg/ml; p <0.001), and remained significantly higher after controlling for demographic and clinical variables.
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            Effect of sinus rhythm restoration after electrical cardioversion on apelin and brain natriuretic Peptide prohormone levels in patients with persistent atrial fibrillation.

            Eleftherios M. Kallergis, Emmanuel G Manios, Emmanuel M Kanoupakis … (2010)
            Because humoral alterations have been implicated in the generation and perpetuation of atrial fibrillation (AF), we aimed to elucidate possible abnormalities in atrial endocrine function in the setting of lone AF. Levels of plasma apelin and amino terminal fragment of the brain natriuretic peptide prohormone (NT-pro-BNP) were measured in 40 patients with persistent AF, before and 1 month after electrical cardioversion, and in 15 controls in sinus rhythm (SR). All patients were successfully cardioverted to SR, although in 9 of them AF recurred. Baseline apelin levels were lower and NT-pro-BNP levels higher in patients with AF compared to controls (380 +/- 186 vs 700 +/- 151 pg/ml, p <0.001, and 615 +/- 611 vs 50 +/- 28 pg/ml, p <0.001, respectively). Maintenance of SR resulted in an increase of apelin and a decrease of NT-pro-BNP levels during the postcardioversion follow-up period compared to baseline (497 +/- 170 vs 368 +/- 178 pg/ml, p <0.001, and 206 +/- 106 vs 398 +/- 269 pg/ml, p <0.001 respectively). Patients who developed AF recurrence by the end of the follow-up period had similar values of apelin and NT-pro-BNP on final and initial evaluations (444 +/- 142 vs 422 +/- 217 pg/ml, p = 0.62, and 1,328 +/- 714 vs 1,362 +/- 862 pg/ml, p = 0.74, respectively). Stepwise logistic regression analysis showed that left atrial diameter (b =-0.49, p = 0.05), and baseline NT-pro-BNP (b = 0.006, p = 0.022), but not apelin, were independent predictors for AF recurrence. In conclusion, this study suggests that endocrine heart function, as judged from apelin and NT-pro-BNP levels, is reversibly modified in the setting of lone AF. This could influence systemic hemodynamics and pharmacologic measures designed to treat this arrhythmia.
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              High-sensitivity C-reactive protein is predictive of successful cardioversion for atrial fibrillation and maintenance of sinus rhythm after conversion.

              Eiichi Watanabe, Hitoshi Hishida, Hitoshi Uchiyama … (2006)
              Cardioversion for atrial fibrillation (AF) is the most effective treatment for the restoration of sinus rhythm (SR). Recently, an elevated level of hs-CRP has been shown to be associated with AF burden, suggesting that inflammation increases the propensity for persistence of AF. We examined whether the level of high-sensitivity C-reactive protein (hs-CRP) was predictive of the outcome of cardioversion for AF. One hundred and six patients with a history of symptomatic AF lasting > or =1 day (age 63+/-14 years, mean+/-S.D.) underwent cardioversion. Echocardiography and hs-CRP assay were performed immediately prior to cardioversion. SR was restored in 84 patients (79%). By using selected cutoff values, multiple discriminant analysis revealed significant associations between successful cardioversion and a shorter duration of AF (AF duration or =60%, OR 0.92, 95% CI 0.86-0.99), and lower hs-CRP level (hs-CRP or =0.06 mg/dL, Cox proportional-hazards regression model found that only hs-CRP level was an independent predictor of AF recurrence (OR 5.30, 95% CI 2.46-11.5) after adjustment for coexisting cardiovascular risks. When patients were divided by the hs-CRP level of 0.06 mg/dL, percentage of maintenance of SR below and above the cutoff was 53% and 4%, respectively (log-rank test, p<0.0001). hs-CRP level determined prior to cardioversion represents an independent predictor of both successful cardioversion for AF and the maintenance of SR after conversion.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Braz J Cardiovasc Surg
                Journal ID (iso-abbrev): Braz J Cardiovasc Surg
                Journal ID (publisher-id): rbccv
                Title: Brazilian Journal of Cardiovascular Surgery
                Publisher: Sociedade Brasileira de Cirurgia Cardiovascular
                ISSN (Print): 0102-7638
                ISSN (Electronic): 1678-9741
                Publication date (Print and electronic): Oct-Dec 2017
                Publication date (Print): Oct-Dec 2017
                Volume: 32
                Issue: 6
                Pages: 530-535
                Affiliations
                [1 ] Central Hospital, Jiading District, Shangai, China.
                Author notes
                Correspondence Address: Xiangdong Xu, Central hospital, Jiading District, 1 Chengbei Road - Jiading District - Shanghai, China - 201800. E-mail: tyqyyyqw@ 123456163.com
                Article
                DOI: 10.21470/1678-9741-2017-0008
                PMC ID: 5731309
                SO-VID: f6c12afc-f15b-4d8e-b402-4d940fab4483
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 10 January 2017
                Date accepted : 29 May 2017
                Funding
                Funded by: Shanghai Municipal Health and Family Planning Commission
                Award ID: ZK2015B09
                Shanghai Municipal Health and Family Planning Commission provided financial support for the project (ZK2015B09).
                Categories
                Subject: Review Article

                Keywords: atrial fibrillation,atrial flutter,electric countershock,natriuretic peptide, brain
                Data availability:
                Keywords: atrial fibrillation, atrial flutter, electric countershock, natriuretic peptide, brain

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