Changes in plasma natriuretic peptide levels in patients with atrial fibrillation after cardioversion

The aim of the study was to assess changes in plasma natriuretic peptide (NP) levels after spontaneous or electrical cardioversion (CV) in patients with paroxysmal or persistent atrial fibrillation (AF).

Patients with paroxysmal or persistent AF with normal left ventricular function and controlled heart rate, referred for electrical CV, were enrolled prospectively. NP concentrations were measured by means of radioimmunoassay method.

We studied 23 patients with paroxysmal and 77 with persistent AF, spontaneously or electrical cardioverted to sinus rhythm. The mean plasma NP levels were increased in AF patients, ANP: 249±88.3 pg/ml and 258±89.7 pg/ml vs 67±21.2 pg/ml; (p<0.001) and BNP: 99.6±29.8 pg/ml and 82.3±33 pg/ml vs 37.5±13 pg/ml; in the paroxysmal, persistent, and control group, respectively. The mean ANP and BNP levels decreased after sinus restoration from 249.0±88.3 pg/ml to 70.1±13 pg/ml, and from 99.6±29.8 pg/ml to 37.4±8.4 pg/ml, respectively, in the paroxysmal group; from 257.7±89.7 pg/ml to 150.0±87.2 pg/ml and from 82.3±33 pg/ml to 63.7±28.6 pg/ml in the persistent AF group. NP levels remained stable for the next 30 days in the group of patients who remained in sinus rhythm.

Plasma NP concentrations are significantly reduced or normalized after sinus rhythm restoration in patients with paroxysmal and persistent AF and remain stable within 4 weeks of follow-up, provided that AF does not recur.