Abstract
Background and PurposeDiagnosis of paroxysmal atrial fibrillation (AF) can be challenging, but it is highly relevant in patients presenting with sinus rhythm and acute cerebral ischemia. We aimed to evaluate prospectively whether natriuretic peptide levels and kinetics identify patients with paroxysmal AF.MethodsPatients with acute cerebral ischemia were included into the prospective observational Find-AF study. N-terminal pro brain-type natriuretic peptide (NT-proBNP), brain-type natriuretic peptide (BNP) and N-terminal pro atrial-type natriuretic peptide (NT-proANP) plasma levels were measured on admission, after 6 and 24 hours. Patients free from AF at presentation received 7 day Holter monitoring. We prospectively hypothesized that patients presenting in sinus rhythm with NT-proBNP>median were more likely to have paroxysmal AF than patients with NT-proBNP<median.Results281 patients were included, of whom 237 (84.3%) presented in sinus rhythm. 220 patients naïve to AF with an evaluable prolonged Holter ECG were analysed. In patients with NT-proBNP>median (239 pg/ml), 17.9% had paroxysmal AF in contrast to 7.4% with NT-proBNP<239 pg/ml (p = 0.025). The ratio of early (0 h) to late (24 h) plasma levels of NT-proBNP showed no difference between both groups. For the detection of paroxysmal atrial fibrillation, BNP, NT-proBNP and NT-proANP at admission had an area under the curve in ROC analysis of 0.747 (0.663–0.831), 0.638 (0.531–0.744) and 0.663 (0.566–0.761), respectively. In multivariate analysis, BNP was the only biomarker to be independently predictive for paroxysmal atrial fibrillation.ConclusionsBNP is independently predictive of paroxysmal AF detected by prolonged ECG monitoring in patients with cerebral ischemia and may be used to effectively select patients for prolonged Holter monitoring.
Highlights
Atrial fibrillation (AF) is a frequent cause of ischemic stroke and patients with atrial fibrillation bear an increased risk for suffering a recurrent stroke [1,2]
Identifying paroxysmal AF may be challenging in these subjects if they are in sinus rhythm at the time of hospitalisation
Prolonged [5] or continued [6] rhythm monitoring may enhance the detection of clinically ‘silent’ paroxysmal AF, but being expensive, time-consuming in terms of evaluation as well as cumbersome for the patient, broad application of such enhanced diagnostics may not be readily available for all unselected patients presenting with cerebral ischemia of unknown cause and sinus rhythm on admission
Summary
Atrial fibrillation (AF) is a frequent cause of ischemic stroke and patients with atrial fibrillation bear an increased risk for suffering a recurrent stroke [1,2]. Identification of paroxysmal AF after cerebral ischemia and initiation of appropriate therapy can be expected to lower morbidity from recurrent stroke. Identifying paroxysmal AF may be challenging in these subjects if they are in sinus rhythm at the time of hospitalisation. Prolonged [5] or continued [6] rhythm monitoring may enhance the detection of clinically ‘silent’ paroxysmal AF, but being expensive, time-consuming in terms of evaluation as well as cumbersome for the patient, broad application of such enhanced diagnostics may not be readily available for all unselected patients presenting with cerebral ischemia of unknown cause and sinus rhythm on admission. Diagnosis of paroxysmal atrial fibrillation (AF) can be challenging, but it is highly relevant in patients presenting with sinus rhythm and acute cerebral ischemia. We aimed to evaluate prospectively whether natriuretic peptide levels and kinetics identify patients with paroxysmal AF
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