Key result
Higher NT-proBNP linked to ~5-fold greater risk of AF cardioversion failure.
Why the study?
AF is common in the ED, but the role of NT-proBNP in predicting cardioversion outcomes and short-term AF recurrence or persistence required investigation.
Does baseline NT-proBNP level predict cardioversion failure and short-term AF recurrence in patients with recent-onset atrial fibrillation?
Observational (n=148)
No
Does baseline NT-proBNP level predict cardioversion failure and short-term AF recurrence in patients with recent-onset atrial fibrillation?
Odds Ratio: 4.8 (95% CI 1.58–14.55)
p-value: p=0.006
Elevated NT-proBNP levels (>580 pg/mL) prior to cardioversion for recent-onset atrial fibrillation can identify patients at high risk for cardioversion failure and early recurrence.
May inform cardioversion risk stratification in recent-onset AF; hypothesis-generating and requires prospective validation before practice change.
Background: Atrial fibrillation (AF) is a common arrhythmia in the emergency department (ED). We investigated the role of N-terminal pro b-type natriuretic peptide (NT-proBNP) in predicting both the outcome of AF cardioversion and the risk of AF recurrence or persistence on the 8th (D8) and 30th (D30) day post-cardioversion. Methods: This prospective, observational study evaluated patients with recent-onset AF, managed by either pharmacological (PC) or electrical cardioversion (EC) in the ED. Patients were treated either immediately or electively after 3 weeks of anticoagulation. NT-proBNP assessments were performed prior to cardioversion. Results: Of the 148 patients enrolled, 56% had paroxysmal AF, 85% underwent immediate cardioversion and 72% received EC. Successful cardioversion to sinus rhythm (SR) was achieved in 85% of patients. Patients with successful cardioversion and those who remained free from AF on D8 had lower NT-proBNP levels compared to patients with failed cardioversion or with AF recurrence or persistence on D8 [day of cardioversion, D0: SR vs. non-SR, 387 (127–1095) pg/mL vs. 1262 (595–2295), p = 0.004; D8: SR vs. non-SR, 370 (127–1095) vs. 1366 (718–2295), p = 0.002]. In multivariate analysis, higher logNT-proBNP was associated with higher risk of cardioversion failure [OR, 95%CI: 4.80 (1.58–14.55), p = 0.006] and AF recurrence or persistence on D8 [OR, 95%CI: 3.65 (1.06–12.59), p = 0.041]. ROC analysis confirmed the predictive ability of NT-proBNP for both outcomes (D0: AUC 0.735, p < 0.001; D8: AUC 0.761, p < 0.001). A cut-off value of NT-proBNP > 580 pg/mL was able to predict failure of AF conversion and occurrence of recurrent/persistent AF at D8. Conclusions: NT-proBNP is a promising biomarker for identifying patients presenting to the ED with recent-onset AF who run a greater risk of cardioversion failure and post-discharge AF recurrence/persistence in the immediate and short term.
No takes yet. Share an insight, caveat, or question.
Diakantonis et al. (2024) conducted an observational in First-diagnosed or paroxysmal Atrial Fibrillation (n=148). Higher logNT-proBNP levels vs. Lower logNT-proBNP levels was evaluated on Failure of AF cardioversion at baseline (OR 4.80, 95% CI 1.58-14.55, p=0.006). Higher logNT-proBNP levels were independently associated with a higher risk of cardioversion failure (OR 4.80) and atrial fibrillation recurrence or persistence at 8 days (OR 3.65).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: