Abstract 13130: Impact of Midregional N-Terminal Pro-Atrial Natriuretic Peptide, Soluble Suppression of Tumorigenicity 2 and Brain Natriuretic Peptide Levels on Heart Rhythm in Persistent Atrial Fibrillation Treated by Electrical Cardioversion: The Biorhythm 2 Study

Abstract

Introduction: We assessed the impact of plasma levels of MRproANP, sST2 and BNP on the maintenance of sinus rhythm at one year after a successful electrical cardioversion of atrial fibrillation. Methods: Prospective, multicenter, observational study including patients undergoing electrical cardioversion of persistent AF. MRproANP, sST2 and BNP were measured in peripheral venous blood before cardioversion. Primary endpoint was recurrent AF detected during the 12 month follow-up, defined as ECG showing AF, or any AF episode lasting >30 seconds on 24 hour Holter monitoring. Results: We included 61 patients from 12/2017 to 03/2019. Average was 67.4±7.8 years, 46 were males (75.4%). Sinus rhythm was restored in 51 patients (83.6%). In these 51 patients, plasma concentrations of MRproANP were significantly higher among patients with recurrent AF at 12 months than among those in sinus rhythm (314.45 [210.90-342.50] vs 214.50 [138.97-264.72] pmol/L, p<0.01). There was no difference between groups in terms of sST2 and BNP concentrations. ROC curve analysis identified an MRproANP threshold of 311.5pmol/L as having the best predictive value for recurrent AF at 12 months. By multivariable analysis, MRproANP >311.5 pmol/L was found to be the sole predictor of AF recurrence (odds ratio 13.57; 95% CI, 2.01-91.54), and identified subjects at very high risk of recurrence (positive predictive value=83.3%). Conclusion: Elevated MRproANP level independently predicts recurrent AF, whereas sST2 and BNP levels do not appear to have any prognostic value in assessing the risk of recurrence of AF at one year after successful electrical cardioversion.