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Relationship between Brain Natriuretic Peptides and Recurrence of Atrial Fibrillation after Successful Direct Current Cardioversion: A Meta‐Analysis
Author(s) -
ZOGRAFOS THEODOROS,
MANIOTIS CHRISTOS,
KATSIVAS APOSTOLOS,
KATRITSIS DEMOSTHENES
Publication year - 2014
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.12477
Subject(s) - medicine , atrial fibrillation , sinus rhythm , confidence interval , meta analysis , cardiology , cochrane library , cardioversion , brain natriuretic peptide , strictly standardized mean difference , medline , natriuretic peptide , heart failure , political science , law
Background Atrial 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. Methods We 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. Results Baseline 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). Conclusions Our 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.