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Baseline NT-ProBNP level predicts success of cardioversion of atrial fibrillation with flecainide.

Amin AS, Peters RH, Verstraaten M, Wilde AA, Buijs EM - Neth Heart J (2015)

Bottom Line: In this prospective single-centre study, we included 112 subsequent patients with acute-onset (< 24 h) symptomatic AF.Echocardiograms were performed ~ 2 weeks after restoration of SR.Cardioversion with flecainide was successful in 91 patients (87 %).

View Article: PubMed Central - PubMed

Affiliation: Heart Center, Departments of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands, a.s.amin@amc.nl.

ABSTRACT

Background: Patients with acute-onset symptomatic atrial fibrillation (AF) can be treated with flecainide. However, flecainide may induce arrhythmias and/or exaggerate heart failure. Therefore, validated markers to predict the efficacy of flecainide and prevent adverse effects are required. We hypothesised that lower NT-proBNP plasma levels correlate with higher success rates of cardioversion with flecainide in patients with AF.

Methods: In this prospective single-centre study, we included 112 subsequent patients with acute-onset (< 24 h) symptomatic AF. Patients with symptoms of heart failure and ECG signs of ischaemia were excluded. Baseline laboratory measurements, including NT-proBNP, were done. Echocardiograms were performed ~ 2 weeks after restoration of SR.

Results: Cardioversion with flecainide was successful in 91 patients (87 %). NT-proBNP was lower in patients with successful cardioversion (P < 0.001). Logistic regression indicated NT-proBNP as an independent predictor of successful cardioversion. A cut-off NT-proBNP value of 1550 pg/ml provided optimal test accuracy to predict successful cardioversion.

Conclusion: In patients with < 24 h of symptomatic AF, NT-proBNP levels up to 1550 pg/ml correlate with high success rates (94 %) of cardioversion with flecainide. Conversely, NT-proBNP higher than 1550 pg/ml correlates with poor success rates (36 %). Further research is needed to validate the predictive value of NT-proBNP for successful cardioversion with flecainide.

No MeSH data available.


Related in: MedlinePlus

Panel a displays baseline plasma NT-proBNP levels (upon admission) during atrial fibrillation in patients who converted to sinus rhythm (SR) versus those who did not convert to SR after intravenous administration of flecainide. N indicates number of patients. Panel b displays the receiver operating curve of plasma NT-pro-BNP levels as a predictor of outcome of cardioversion with intravenous flecainide. Panel c displays the proportion of patients who converted to SR after intravenous administration of flecainide who had baseline plasma NT-proBNP levels lower than 1550 pg/ml or higher than 1550 pg/ml
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Fig1: Panel a displays baseline plasma NT-proBNP levels (upon admission) during atrial fibrillation in patients who converted to sinus rhythm (SR) versus those who did not convert to SR after intravenous administration of flecainide. N indicates number of patients. Panel b displays the receiver operating curve of plasma NT-pro-BNP levels as a predictor of outcome of cardioversion with intravenous flecainide. Panel c displays the proportion of patients who converted to SR after intravenous administration of flecainide who had baseline plasma NT-proBNP levels lower than 1550 pg/ml or higher than 1550 pg/ml

Mentions: Patient characteristics at baseline (before cardioversion) are displayed in Table 1. Age, proportion of men, body mass index, CHA2DS2-VASc score, drug use, and the prevalence of common conditions associated with AF (e.g., coronary artery disease, hypertension, diabetes, thyroid disease, and smoking) did not differ between patients with successful cardioversion with flecainide and patients in whom SR could not be obtained with flecainide. However, baseline plasma NT-proBNP level was significantly lower in patients who converted to SR than in patients in whom SR could not be obtained with flecainide (P < 0.001; Table 1 and Fig. 1a). Left atrial diameter was significantly larger in patients who did not convert to SR than patients who obtained SR after flecainide (P = 0.019). The logistic regression model included the following patient characteristics as covariates (P < 0.20 at univariate analysis): age, heart rate, history of thyroid disease, left atrial diameter and log NT-proBNP. Logistic regression analysis indicated log NT-proBNP as the only independent predictor of cardioversion outcome with flecainide (P = 0.002). Left atrial diameter did not reach statistical significance as an independent predictor of cardioversion outcome (P = 0.078).Figure 1


Baseline NT-ProBNP level predicts success of cardioversion of atrial fibrillation with flecainide.

Amin AS, Peters RH, Verstraaten M, Wilde AA, Buijs EM - Neth Heart J (2015)

Panel a displays baseline plasma NT-proBNP levels (upon admission) during atrial fibrillation in patients who converted to sinus rhythm (SR) versus those who did not convert to SR after intravenous administration of flecainide. N indicates number of patients. Panel b displays the receiver operating curve of plasma NT-pro-BNP levels as a predictor of outcome of cardioversion with intravenous flecainide. Panel c displays the proportion of patients who converted to SR after intravenous administration of flecainide who had baseline plasma NT-proBNP levels lower than 1550 pg/ml or higher than 1550 pg/ml
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4352147&req=5

Fig1: Panel a displays baseline plasma NT-proBNP levels (upon admission) during atrial fibrillation in patients who converted to sinus rhythm (SR) versus those who did not convert to SR after intravenous administration of flecainide. N indicates number of patients. Panel b displays the receiver operating curve of plasma NT-pro-BNP levels as a predictor of outcome of cardioversion with intravenous flecainide. Panel c displays the proportion of patients who converted to SR after intravenous administration of flecainide who had baseline plasma NT-proBNP levels lower than 1550 pg/ml or higher than 1550 pg/ml
Mentions: Patient characteristics at baseline (before cardioversion) are displayed in Table 1. Age, proportion of men, body mass index, CHA2DS2-VASc score, drug use, and the prevalence of common conditions associated with AF (e.g., coronary artery disease, hypertension, diabetes, thyroid disease, and smoking) did not differ between patients with successful cardioversion with flecainide and patients in whom SR could not be obtained with flecainide. However, baseline plasma NT-proBNP level was significantly lower in patients who converted to SR than in patients in whom SR could not be obtained with flecainide (P < 0.001; Table 1 and Fig. 1a). Left atrial diameter was significantly larger in patients who did not convert to SR than patients who obtained SR after flecainide (P = 0.019). The logistic regression model included the following patient characteristics as covariates (P < 0.20 at univariate analysis): age, heart rate, history of thyroid disease, left atrial diameter and log NT-proBNP. Logistic regression analysis indicated log NT-proBNP as the only independent predictor of cardioversion outcome with flecainide (P = 0.002). Left atrial diameter did not reach statistical significance as an independent predictor of cardioversion outcome (P = 0.078).Figure 1

Bottom Line: In this prospective single-centre study, we included 112 subsequent patients with acute-onset (< 24 h) symptomatic AF.Echocardiograms were performed ~ 2 weeks after restoration of SR.Cardioversion with flecainide was successful in 91 patients (87 %).

View Article: PubMed Central - PubMed

Affiliation: Heart Center, Departments of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands, a.s.amin@amc.nl.

ABSTRACT

Background: Patients with acute-onset symptomatic atrial fibrillation (AF) can be treated with flecainide. However, flecainide may induce arrhythmias and/or exaggerate heart failure. Therefore, validated markers to predict the efficacy of flecainide and prevent adverse effects are required. We hypothesised that lower NT-proBNP plasma levels correlate with higher success rates of cardioversion with flecainide in patients with AF.

Methods: In this prospective single-centre study, we included 112 subsequent patients with acute-onset (< 24 h) symptomatic AF. Patients with symptoms of heart failure and ECG signs of ischaemia were excluded. Baseline laboratory measurements, including NT-proBNP, were done. Echocardiograms were performed ~ 2 weeks after restoration of SR.

Results: Cardioversion with flecainide was successful in 91 patients (87 %). NT-proBNP was lower in patients with successful cardioversion (P < 0.001). Logistic regression indicated NT-proBNP as an independent predictor of successful cardioversion. A cut-off NT-proBNP value of 1550 pg/ml provided optimal test accuracy to predict successful cardioversion.

Conclusion: In patients with < 24 h of symptomatic AF, NT-proBNP levels up to 1550 pg/ml correlate with high success rates (94 %) of cardioversion with flecainide. Conversely, NT-proBNP higher than 1550 pg/ml correlates with poor success rates (36 %). Further research is needed to validate the predictive value of NT-proBNP for successful cardioversion with flecainide.

No MeSH data available.


Related in: MedlinePlus