It has been reported previously that elevated N-terminal pro-brain natriuretic peptide levels (BNP) decrease in patients with atrial fibrillation (AF) within one month of pulmonary vein isolation (PVI). The purpose of the study was to examine the development of BNP levels after successful PVI. In 71 patients (mean age of 62 ± 8 years) undergoing successful PVI for drug-resistant highly symptomatic paroxysmal or shortly persistent AF, BNP levels were analysed the day before, 30 days after, three months after and one year after the procedure, respectively. Based on a personal log of duration and frequency of symptoms and repetitive 24h-ECG recordings, patients were divided into two groups: 36 patients had clinical success, and 16 patients had clinical failure. Clinical demographic and procedural data were similar in both groups. Of note, all patients had lone AF without any clinical signs of congestive heart failure. Baseline BNP levels were similar in both groups (387± 550 pg/ml vs. 492 ± 513 pg/ml, p=0.6). After 30 days, patients who had a clinical successful procedure showed a significant decrease of BNP levels compared to those patients with clinical failure (315 ± 430 pg/ml vs. 754 ± 888 pg/ml, p=0.02). After three months, a further reduction of BNP levels could be observed in clinical successful treated patients compared to patients with clinical failure, in whom no significant change compared to baseline could be detected (214 ± 213 pg/ml vs. 673 ± 907 pg/ml, p=0.01). After one year of successful PVI a repeated reduction of BNP in patients with clinical success could be observed (173 ± 198 pg/ml vs. 448 ± 628 pg/ml, p=ns.), but due to the small sample size the difference did not reach statistic significance. Similar to previous observations, BNP levels after successful PVI decreased only in patients with clinical success during follow-up. However, our study revealed a long-term effect showing a further decrease after one year whereas BNP levels showed even a further increase during the first three months in patients without clinical success. This observation points to an underestimated impact of AF concerning congestive heart failure even in patients without regarding symptoms.
N‐terminal pro brain natriuretic peptide eliminates the prognostic effect of atrial fibrillation in patients with chronic heart failure
