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. 2015 Mar;23(3):182-9.
doi: 10.1007/s12471-015-0659-8.

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

Ahmad Shoaib Amin  1 , René H J Peters, Maaike Verstraaten, Arthur A M Wilde, Eugène M Buijs
Affiliations

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

Ahmad Shoaib Amin et al. Neth Heart J. 2015 Mar.

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.

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Figures

Figure 1
Figure 1
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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