MR-proANP, sST2, BNP and sinus rhythm maintenance 1 year after electrical cardioversion for atrial fibrillation.

Background: We assessed the ability of MR-proANP, sST2 and BNP to predict maintenance of sinus rhythm at one year after successful electrical cardioversion of atrial fibrillation.

Methods: Prospective, multicenter, observational study including patients undergoing electrical cardioversion of persistent AF. MR-proANP, sST2 and BNP were measured in peripheral venous blood before cardioversion. Primary endpoint was the first recurrence of AF during the 12-month follow-up, defined as ECG showing AF, or any AF episode lasting > 30 s on 24 h holter monitoring.

Results: We included 61 patients from 12/2017 to 03/2019 with preserved LVEF (≥ 45%), average age 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 MR-proANP were significantly higher among patients with recurrent AF at 12 months than among those without recurrence (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 MR-proANP threshold of 311.5 pmol/L as having the best predictive value for recurrent AF at 12 months. By multivariable analysis, MR-proANP > 311.5 pmol/L was found to be the sole predictor of AF recurrence (hazard ratio, 4.74; 95% CI, 1.59-14.07), and identified subjects at very high risk of recurrence (positive predictive value = 83.3%).

Conclusion: Elevated MR-proANP level independently predicts recurrent AF during the year following electrical cardioversion of atrial fibrillation. Our findings warrant confirmation in larger studies.

Trial Registration: Registered with ClinicalTrials.gov under the identifier NCT03351816 on 2017-11-20.