Preprocedural BNP levels were significantly higher in patients with atrial fibrillation recurrence versus those maintaining sinus rhythm after cardioversion (SMD -1.51; 95% CI -2.53, -0.48; P=0.004).
Meta-Analysis
Are preprocedural BNP and NT-proBNP levels associated with atrial fibrillation recurrence after successful direct current cardioversion?
Low preprocedural BNP and NT-proBNP levels are associated with sinus rhythm maintenance after successful direct current cardioversion for atrial fibrillation.
Standardized Mean Difference: -1.51 (95% CI -2.53–-0.48)
p-value: p=0.004
BACKGROUND: Atrial fibrillation (AF) recurrence is common after successful direct current cardioversion (DCCV), with a 40% rate of recurrence within the first month. Several studies have investigated the potential association between brain natriuretic peptide (BNP) or N-terminal (NT)-proBNP levels before DCCV and the risk of AF recurrence, but results have been inconsistent. We, therefore, conducted a systematic review and meta-analysis of all available data to determine whether sinus rhythm (SR) maintenance after successful DCCV may be determined by preprocedural BNP and NT-proBNP levels. METHODS: We systematically searched Scopus, the Cochrane library, EMBASE, and MEDLINE databases to identify publications evaluating BNP or NT-proBNP levels in relation to post-DCCV AF recurrence, indexed from inception to September 2013. Among the initial 1,067 citations, 18 studies fulfilled the specified criteria. The difference in BNP and NT-proBNP concentrations in the AF recurrence and the SR-maintaining group was estimated by the standardized mean difference and the estimates of the pooled outcomes were evaluated using random-effects models. RESULTS: Baseline BNP levels in the AF recurrence group were significantly higher compared to BNP levels in the SR-maintaining group (standardized mean difference SMD -1.51, confidence interval CI -2.53, -0.48, P = 0.004). Similar results were observed for NT-proBNP levels, which were significantly higher in the AF recurrence group compared with the SR-maintaining group (SMD -0.63, CI -1.13, -0.14, P = 0.01). CONCLUSIONS: Our analysis suggests that low preprocedural BNP/NT-proBNP levels are associated with SR maintenance. The use of BNP or NT-proBNP for prediction of long-term response to DCCV appears to be useful and should be further evaluated.
Zografos et al. (Tue,) conducted a meta-analysis in Atrial fibrillation. Preprocedural BNP and NT-proBNP levels vs. Sinus rhythm maintenance was evaluated on Difference in BNP concentrations in the AF recurrence and the SR-maintaining group (SMD -1.51, 95% CI -2.53, -0.48, p=0.004). Preprocedural BNP levels were significantly higher in patients with atrial fibrillation recurrence versus those maintaining sinus rhythm after cardioversion (SMD -1.51; 95% CI -2.53, -0.48; P=0.004).