• Pacing Clin Electrophysiol · Nov 2014

    Meta Analysis

    Relationship between brain natriuretic peptides and recurrence of atrial fibrillation after successful direct current cardioversion: a meta-analysis.

    • Theodoros Zografos, Christos Maniotis, Apostolos Katsivas, and Demosthenes Katritsis.
    • Department of Cardiology, Athens Red Cross Hospital, Athens, Greece; Department of Cardiology, Athens Euroclinic, Athens, Greece.
    • Pacing Clin Electrophysiol. 2014 Nov 1; 37 (11): 1530-7.

    BackgroundAtrial fibrillation (AF) recurrence is common after successful direct current cardioversion (DCCV), with a 40% rate of recurrence within the first month. Several studies have investigated the potential association between brain natriuretic peptide (BNP) or N-terminal (NT)-proBNP levels before DCCV and the risk of AF recurrence, but results have been inconsistent. We, therefore, conducted a systematic review and meta-analysis of all available data to determine whether sinus rhythm (SR) maintenance after successful DCCV may be determined by preprocedural BNP and NT-proBNP levels.MethodsWe systematically searched Scopus, the Cochrane library, EMBASE, and MEDLINE databases to identify publications evaluating BNP or NT-proBNP levels in relation to post-DCCV AF recurrence, indexed from inception to September 2013. Among the initial 1,067 citations, 18 studies fulfilled the specified criteria. The difference in BNP and NT-proBNP concentrations in the AF recurrence and the SR-maintaining group was estimated by the standardized mean difference and the estimates of the pooled outcomes were evaluated using random-effects models.ResultsBaseline BNP levels in the AF recurrence group were significantly higher compared to BNP levels in the SR-maintaining group (standardized mean difference [SMD] -1.51, confidence interval [CI] [-2.53, -0.48], P = 0.004). Similar results were observed for NT-proBNP levels, which were significantly higher in the AF recurrence group compared with the SR-maintaining group (SMD -0.63, CI [-1.13, -0.14], P = 0.01).ConclusionsOur analysis suggests that low preprocedural BNP/NT-proBNP levels are associated with SR maintenance. The use of BNP or NT-proBNP for prediction of long-term response to DCCV appears to be useful and should be further evaluated.©2014 Wiley Periodicals, Inc.

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