Alternations in atrial natriuretic peptide release after DC cardioversion of non-valvular chronic atrial fibrillation

Abstract

The response of atrial natriuretic peptide (ANP) release to haemodynamic influences after cardioversion of atrial fibrillation has not been fully examined. We measured plasma concentrations of ANP and assessed haemodynamic changes 60-120 min after DC cardioversion in 22 patients with non-valvular chronic atrial fibrillation. Passive leg elevation to enhance volume expansion was performed 60 min after DC cardioversion. Sinus rhythm was restored in 18 of the 22 patients (successful DC cardioversion group). The control group consisted of seven patients with non-valvular chronic atrial fibrillation who did not undergo DC cardioversion (atrial fibrillation control group). In the successful DC cardioversion group, the mean pulmonary artery wedge pressure decreased significantly 15 min after cardioversion (P < 0.05) and then remained unchanged. Plasma concentrations of ANP also decreased significantly 15 min after cardioversion (P < 0.05). Furthermore, there was an additional significant decrease in ANP levels for up to 60 min after cardioversion (P < 0.05 from 15 min). Passive leg elevation for 15 min led to an increase in the mean pulmonary artery wedge pressure (P < 0.01) and right atrial pressure (P < 0.05), but did not result in increased plasma concentrations of ANP (47.1 +/- 27.6 vs 43.9 +/- 34.4 pg.ml-1, mean +/- SD, P = ns). In the atrial fibrillation control group, passive leg elevation increased the mean pulmonary artery wedge pressure (P < 0.01), the mean right atrial pressure (P < 0.05) and plasma concentrations of ANP (139.9 +/- 85.8 vs 168.1 +/- 108.2, P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Time course for recovery of atrial mechanical and endocrine function post DC cardioversion for persistent atrial fibrillation

“…A decrease in plasma ANP following successful DC cardioversion has previously been described [10][11][12]. Petersen et al [12] showed a fall in plasma ANP levels (n=8) 24 h after successful electrical cardioversion of AF, which then remained stable for 30 days.…”

“…Arakawa et al [10] showed an immediate decrease in plasma ANP levels after successful DC cardioversion for AF. The effect of volume expansion (to increase pulmonary wedge and right atrial pressures) on plasma ANP levels was assessed 60 min post-cardioversion and compared to a control group of patients with AF not undergoing cardioversion.…”

“…DC cardioversion of AF requires general anesthesia and the application of electrical energy. Plasma ANP levels remain unchanged following unsuccessful cardioversion [10,11]. It is likely that change in atrial rhythm has a major effect on ANP production/release.…”

“…Plasma ANP levels are elevated in persistent AF, independently of left atrial size [9]. Plasma ANP levels decrease immediately post DC cardioversion [10]; however, little is known regarding longer-term changes. Improved comprehension of the nature and time course of disturbances of atrial function post DC cardioversion may contribute to our understanding of why many patients subsequently revert to AF.…”

Level of natriuretic peptide Determines outcome in atrial fibrillation

“…[16][17][18][19][20] In contrast, during prolonged AF, ANP level may not be increased because of failure of the atrial productive capacity with structural atrial damage. [21][22] However, most of these studies included subjects with underlying structural heart disease that may have biased the results.…”