Key result
Baseline plasma NT-proBNP levels below 1550 pg/ml predicted a 94% success rate for cardioversion with flecainide in patients with acute-onset atrial fibrillation, compared to 36% in patients with higher levels.
Why the study?
Does baseline NT-proBNP level predict the success of cardioversion with flecainide in patients with acute-onset symptomatic atrial fibrillation?
Observational (n=112)
No
Does baseline NT-proBNP level predict the success of cardioversion with flecainide in patients with acute-onset symptomatic atrial fibrillation?
Effect estimate: AUC 0.8797 (95% CI 0.7932-0.9663)
Absolute Event Rate: 94% vs 36%
p-value: p=<0.001
Baseline NT-proBNP levels ≤1550 pg/ml strongly predict successful cardioversion with flecainide in patients with acute-onset atrial fibrillation.
May support NT-proBNP-guided selection for flecainide cardioversion in acute AF; hypothesis-generating and requires prospective validation.
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 takes yet. Share an insight, caveat, or question.
Amin et al. (2015) conducted an observational in Acute-onset symptomatic atrial fibrillation (n=112). Baseline NT-proBNP < 1550 pg/ml vs. Baseline NT-proBNP > 1550 pg/ml was evaluated on Successful cardioversion to sinus rhythm with flecainide (AUC 0.8797, 95% CI 0.7932-0.9663, p=<0.001). Baseline plasma NT-proBNP levels below 1550 pg/ml predicted a 94% success rate for cardioversion with flecainide in patients with acute-onset atrial fibrillation, compared to 36% in patients with higher levels.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: