Plasma cardiac natriuretic peptides as biochemical markers of recurrence of atrial fibrillation in patients with mild congestive heart failure

To determine changes in plasma brain natriuretic peptide (BNP) after direct current cardioversion (DC) and to evaluate the relationship between plasma atrial natriuretic peptide (ANP) and BNP and the recurrence of atrial fibr illation (AF) after DC in patients with mild congestive heart failure (CHF) , plasma ANP and BNP were measured before and after DC in 71 patients with mild CHF and then followed. In 65 patients with successful DC, both ANP and BNP decreased 15 min after DC. Cox stepwise multivariate analysis among 14 variables such as age, history of AF, echocardiographic parameters, medica tion and ANP and BNP revealed that only low ANP (p=0.005) and high BNP befo re DC (p=0.0002) were independent predictors of recurrent AF. A ratio of AN P to BNP less than 0.44 was a significant risk factor for AF recurrence by Kaplan-Meier analysis (p=0.02). BNP began to decrease immediately after suc cessful DC. High BNP and relatively low ANP compared with BNP were independ ent risk factors of AF recurrence in patients with mild CHF.