Plasma levels of NT-pro-BNP in patients with atrial fibrillation before and after electrical cardioversion

Abstract Background Biomarkers may help to improve our knowledge about the complex pathophysiology of atrial fibrillation (AF), the most common sustained cardiac arrhythmia. We aimed to identify significant changes in biomarkers and clinical measures in patients with and without AF recurrence after electrical cardioversion. Methods Patients with persistent AF undergoing elective electrical cardioversion were enrolled. We measured 21 conventional and new biomarkers before and 30 days after electrical cardioversion and assessed the associations of changes in biomarker levels with rhythm status at follow-up using multivariable logistic regression models. Results Of the 100 patients included (mean [SD] age 66 (10) years, 25% women), 28 (28%) had an AF recurrence. Of the 21 biomarkers assessed, 4 reached the predefined between group significance of p<0.01. The most significant ones were bone morphogenetic protein 10 (BMP10), N-terminal pro-B-type natriuretic peptide (NT-proBNP) and total bilirubin. Their respective changes were -10.4%, -62.0% and -25.6% in patients with sinus rhythm, and 3.1%, 1.1% and -9.4% in patients with recurrent AF, for a between group difference of -13.5% (95% confidence interval [CI], -19.3% to -7.6%; P<0.001), -63.1% (95% CI, -76.6% to -49.6%; P<0.001) and -16.3 (95% CI, -27.9% to -4.7%; P=0.007). In age and sex adjusted models, reductions of BMP10 and NT-proBNP were significantly associated with rhythm status at follow-up (β coefficient per 1-SD decrease, -2.03; 95% CI, -3.06 to -1.00; P<0.001 and -3.98; 95% CI, -5.75 to -2.22; P<0.001, respectively). After additional adjustment for demographic characteristics, risk factors for AF, and changes in clinical measures, the β coefficients per 1-SD were -3.85 (95% CI, -6.34 to -1.35; P=0.003) for BMP10 and -5.84 (95% CI, -10.22 to -1.47; P=0.009) for NT-proBNP. Conclusions Changes in BMP10 und NT-proBNP levels were strongly associated with rhythm status after electrical cardioversion, suggesting that these markers may be dependent on the actual heart rhythm.

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Abstract 18105: Comparison of Efficacy and Safety of Two Dosages Dabigatran versus Warfarin in Patients with Persistent and Long-standing Atrial Fibrillation Undergoing Electrical Cardioversion

Circulation ◽

10.1161/circ.130.suppl_2.18105 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Oskars Kalejs ◽

Olga Litunenko ◽

Sandis Sakne ◽

Aldis Strelnieks ◽

Marina Kovalova ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Warfarin Therapy ◽

Electrical Cardioversion ◽

Efficacy And Safety ◽

Bleeding Rate ◽

Warfarin Group ◽

Before And After ◽

Long Acting ◽

Atrial Thrombi

Introduction: The most important factor for efficacy and safety for patients with atrial fibrillation (AF) undergoing electrical cardioversion (ECV) is appropriate use of oral anticoagulant (OAC) therapy. Dabigatran is a possible alternative OAC therapy before and after ECV versus therapy with warfarin. Methods: We have analysed the data collected before, during and after ECV in 1046 patients (pts) undergoing ECV. All pts had AF, 885 defined as persistent and 161 defined as long-acting, mean CHA2DS2 VASc score was 3.1 ± 1.8, 735 had one or two ECV in anamnesis. 628 (60%) pts started the use of dabigatran, (405 pts 150 mg twice or 223 pts 110 mg twice) before ECV for at least 21 day, 418 (40%) started warfarin therapy, 21 day start after INR was in range 2.0 - 3.0. Transesophageal echocardiography (TEE) was encouraged before ECV in all groups for pts with CHA2DS2VASc score ≥ 3, markedly left atrial dilatation and AF duration ≥ 6 months. ECG and Echo-kg data were analysed 30 and 90 days after ECV. Results: ECV was successful after first shock in 962 (91.7%) pts, in total successful ECV - in 1029 (98.37%) pts. Left atrial thrombi were detected on TEE before ECV in 7 pts in dabigatran group and 12 pts in warfarin group, so, pts continued OAC therapy for one month, and TEE had been performed again. 3 pts in dabigatran (150 mg twice) group and 2 pts in warfarin group were free of thrombus and have been referred to ECV. Average time for treatment before ECV was significantly lower for dabigatran (25 days) vs warfarin (44 days, p<0.01). Stroke and systemic embolism rates at 90 days were lower in both dabigatran group (0.1%) vs warfarin group (1.4%). There was no difference in analysis of events between TEE and non-TEE pts. Dabigatran pts had significantly lower clinical relevant bleeding rate vs warfarin (D 110 mg 0, D 150 mg 0.47% vs W 2.87%, p<0.04). Conclusions: Dabigatran 150 mg and 110 mg twice is a safe, effective and reasonable alternative to warfarin for patients undergoing ECV despite CHA2DS2VASc risk score and AF duration. The frequencies of stroke and embolic events were lower in dabigatran 150 mg and 110 mg versus warfarin with lower bleeding rates within 30 and 90 days after ECV. Patients undergoing dabigatran therapy have shorter time before procedures and can save time for INR test in normal range.

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Cerebral Blood Flow before and after Cardioversion of Atrial Fibrillation

Journal of Cerebral Blood Flow & Metabolism ◽

10.1038/jcbfm.1989.62 ◽

1989 ◽

Vol 9 (3) ◽

pp. 422-425 ◽

Cited By ~ 73

Author(s):

Palle Petersen ◽

Jens Kastrup ◽

Regitze Videbæk ◽

Gudrun Boysen

Keyword(s):

Atrial Fibrillation ◽

Blood Flow ◽

Cerebral Blood Flow ◽

Sinus Rhythm ◽

Electrical Cardioversion ◽

Initial Slope ◽

Cerebrovascular Complications ◽

Before And After ◽

End Tidal

In nine patients with atrial fibrillation (AF) of <3 months' duration, CBF was measured the day before and after and again 30 days after electrical cardioversion therapy to sinus rhythm. The day before cardioversion therapy, median CBF (expressed as initial slope index 1, ml/100 g · min−1) was 35.8 and the day after it was 37.1. After 30 days in sinus rhythm, CBF was 39.4 (NS), although the end-tidal Pco2 values were lower than the pretreatment values. After correction for changes in end-tidal Pco2, the median CBF had increased significantly from 35.8 to 40.3 on day 1 and to 46.7 on day 30. The reduced CBF during AF could be a contributing factor in the development of cerebrovascular complications in patients with AF.

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