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Drop in plasma brain natriuretic peptide levels after successful direct current cardioversion in chronic atrial
Y Ohta1, T Shimada, H Yoshitomi
1Shimane Medical University, Enya-cho, Japan.
Background:
According to previous reports, plasma atrial natriuretic peptide levels increase in atrial fibrillation (AF) and decrease after successful direct current (DC) cardioversion, but there have been no reports on plasma brain natriuretic peptide (BNP).
Objective:
To determine whether plasma BNP levels decrease after successful direct DC cardioversion in patients with chronic AF.
Patients And Methods:
Twenty patients who remained in sinus rhythm for at least seven days after cardioversion, and 20 normal control subjects, were studied. Group A consisted of 10 patients with underlying heart disease, including dilated cardiomyopathy (n=2), hypertrophic cardiomyopathy (n=1), mitral valve disease (n=3), hypertensive heart disease (n=3) and status after atrial septal closure (n=1). Group B consisted of 10 patients with just AF. Group C (serving as controls) comprised 20 subjects with normal sinus rhythm and no risk factors.
Results:
Before cardioversion, plasma BNP levels were higher in group A (176.7+/-128.1 ng/mL) and in group B (96.8+/-51.7 ng/ml) than in group C (6.3+/-3.8 ng/ml) (P<0.01 for all). After successful cardioversion, mean plasma BNP levels in groups A and B decreased from 136.8+/-105.5 ng/mL to 46.4+/-44.2 ng/mL (P<0.01). In group A, plasma BNP levels decreased from 176.7+/-128.1 ng/mL to 62.5+/-54.6 ng/mL (P<0.01), and in group B, plasma BNP levels decreased from 96.8+/-51.7 ng/mL to 30.3+/-23.8 ng/mL (P<0.01).
Conclusions:
Lone AF raises plasma BNP levels, which is more marked if there is underlying structural heart disease present, and cardioversion reduces plasma BNP levels. Therefore, high plasma BNP levels in patients with chronic AF are likely to be caused by AF and reflect cardiac overloading associated with, although contributed to in part by, underlying heart diseases.