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Short-term fluctuations of plasma NT-proBNP levels in patients with new-onset atrial fibrillation: a way to assess time of onset?
  1. S Deftereos1,
  2. G Giannopoulos1,
  3. C Kossyvakis1,
  4. K Raisakis1,
  5. A Theodorakis2,
  6. A Kaoukis1,
  7. K Toli3,
  8. V Panagopoulou1,
  9. M Driva1,
  10. I Mantas3,
  11. V Pyrgakis1,
  12. M A Alpert4
  1. 1Department of Cardiology, Athens General Hospital “G. Gennimatas”, Athens, Greece
  2. 2Department of Cardiology, Messologi General Hospital, Messologi, Greece
  3. 3Department of Cardiology, Chalkida General Hospital, Chalkida, Greece
  4. 4Division of Cardiology, University of Missouri, School of Medicine, Columbia, Missouri, USA
  1. Correspondence to Dr Georgios Giannopoulos, Department of Cardiology, Athens General Hospital “G. Gennimatas”, 154 Mesogeion Ave., Athens 11527, Greece; ggiann{at}


Objective The objective of this study was to characterise short-term kinetics of plasma amino-terminal pro-B natriuretic peptide (NT-proBNP) levels in patients with new-onset atrial fibrillation (AF) without heart failure.

Design Prospective cohort study.

Setting Emergency departments and inpatient services of three large community hospitals.

Patients 31 consecutive patients with new-onset atrial fibrillation (<24 h before presentation) persisting at least 48 h, without evidence of heart failure.

Main outcome measures Plasma NT-proBNP levels were obtained at presentation and then 6, 12, 18, and 24 h after presentation. A final sample was obtained 48 h after onset of AF.

Results Mean plasma NT-proBNP levels and 95% CIs (pg/ml) during the 48-h period following onset of AF were: 0–6 h: 636 (395 to 928), 6–12 h: 1364 (951 to 1778), 12–18 h: 1747 (1412 to 2083), 18–24 h: 1901 (1549 to 2253), 24–36 h: 1744 (1423 to 2066) and 36–48 h: 1101 (829 to 1373). Mean time to peak NT-proBNP levels was 16.7 (0.7) h; 29 patients reached their peak levels within 24 h. The mean peak NT-proBNP level was significantly higher than those obtained at 0–6 h and at 36–48 h after onset of AF (p<0.001 for both). There was no correlation between ventricular rate and plasma NT-proBNP levels during any time period after onset of AF.

Conclusion In patients with new-onset AF but no clinical or radiographic evidence of heart failure, plasma NT-proBNP levels rise progressively to a peak during the first 24 h and then rapidly fall. This pattern may serve as an aid to assess the time from AF onset.

  • Atrial fibrillation
  • amino-terminal pro-B natriuretic peptide
  • new onset

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  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the Review Boards of participating Hospitals.

  • Provenance and peer review Not commissioned; externally peer reviewed.