Elsevier

American Heart Journal

Volume 135, Issue 6, June 1998, Pages 1040-1047
American Heart Journal

N-terminal proANF in acute atrial fibrillation: A biochemical marker of atrial pressures but not a predictor for conversion to sinus rhythm,☆☆,

Supported by the Swedish Society of Cardiology, Draco Läkemedel AB, Lund, Sweden, and the Göteborg Medical Society. Support with trial drugs and logistics from Draco Läkemedel AB, Lund, Sweden.
https://doi.org/10.1016/S0002-8703(98)70070-5Get rights and content

Abstract

Background: Atrial filling pressures are increased in acute atrial fibrillation, which stimulates the release of atrial natriuretic factor pro-hormone, proANF. Methods: In a randomized trial comparing digoxin with placebo in 216 patients, we investigated whether the baseline plasma level of N-terminal proANF is a predictor for conversion to sinus rhythm and the relation among N-terminal proANF, conversion to sinus rhythm, and changes in heart rate. Results: N-terminal proANF was increased at baseline and decreased significantly in patients converting to sinus rhythm, whereas it was mainly unchanged in nonconverters. N-terminal proANF was not a predictor of conversion to sinus rhythm. A relation was found between relative changes in heart rate and N-terminal proANF in nonconverters. Conclusion: The level of N-terminal proANF does not predict conversion to sinus rhythm, which indicates that hemodynamics per se is not important. There is a correlation between relative changes in heart rate and N-terminal proANF in nonconverters. (Am Heart J 1998;135:1040-7.)

Section snippets

Methods

The patients in this study are a subsample from the Digitalis in Acute Atrial Fibrillation Trial.30 This trial was performed in 13 Swedish hospitals and was a randomized double-blind comparison of intravenously administered digoxin and placebo in patients with acute atrial fibrillation. The primary end point was conversion to sinus rhythm within 16 hours after randomization. Patients older than 18 years of age presenting with atrial fibrillation with a maximal duration of 7 days were eligible.

Baseline characteristics

Between February 1993 and June 1994, 239 patients were included in the Digitalis in Acute Atrial Fibrillation Trial. In 216 patients samples for N-terminal proANF analysis were available. Of these, 98 were women. The mean age was 65.9 ± 13.3 years (range 21 to 89 years), and the mean body weight was 78.4 ± 15.0 kg (range 45 to 160 kg). In 116 patients this was the first episode of atrial fibrillation, whereas in 100 it was a recurrent arrhythmia. The results concerning conversion to sinus

Discussion

Our study shows that N-terminal proANF is markedly increased in patients with acute atrial fibrillation and that the plasma levels decrease substantially after conversion to sinus rhythm. The plasma level of N-terminal proANF at baseline does not predict conversion to sinus rhythm within 16 hours of observation. Furthermore a correlation between relative changes in heart rate and N-terminal proANF was found in patients remaining in atrial fibrillation.

On hemodynamic evaluation atrial

Acknowledgements

We thank Gunilla Norman, RN, and Eva Alfvegren, RN, Department of Internal Medicine, Division of Cardiology, Östra University Hospital, Göteborg for excellent support in coordinating the study. We also thank Lars Frison, PhD, Astra Hässle, AB, Mölndal for invaluable help with statistical methods and interpretation.

References (48)

  • M Naito et al.

    The hemodynamic consequences of cardiac arrhythmias: evaluation of the relative roles of abnormal atrioventricular sequencing, irregularity of ventricular rhythm and atrial fibrillation in a canine model

    Am Heart J

    (1983)
  • G Thibault et al.

    The propeptide Asn 1-Tyr 126 is the storage form of rat natriuretic factor

    Biochem J

    (1987)
  • JA Sundsfjord et al.

    Identification and plasma concentrations of the N-terminal fragment of proatrial natriuretic factor in man

    J Clin Endocrinol Metab

    (1988)
  • H Itoh et al.

    Gamma-atrial natriuretic polypeptide (gammaANP) -derived peptides in human plasma: cosecretion of N-terminal gammaANP fragment and alfaANP

    J Clin Endocrinol Metab

    (1988)
  • F. Valsson

    Atrial natriuretic peptide

    Studies in cardiac surgical patients with acute renal failure or myocardial ischemia

    (1996)
  • N Katsube et al.

    Atriopeptin turnover: quantitative relationship between in vivo changes in plasma level and atrial content

    J Pharm Exp Ther

    (1986)
  • CJ Winters et al.

    The N-terminus and a 4000-MW peptide from the midportion of the N-terminus of the atrial natriuretic prohormone each circulate in humans and increase in congestive heart failure

    Circulation

    (1989)
  • JR. Dietz

    Release of natriuretic factor from rat heart-lung preparation by atrial distension

    Am J Physiol

    (1984)
  • JR Dietz et al.

    Release of ANF, proANF 1-98 and proANF 31-67 from isolated rat atria by atrial distension

    Am J Physiol

    (1991)
  • J-C Dussaule et al.

    Plasma atrial natriuretic factor and cyclic GMP in mitral stenosis treated by balloon valvulotomi. Effect of atrial fibrillation

    Circulation

    (1988)
  • IG Crozier et al.

    Atrial natriuretic peptide in spontaneous tachycardias

    Br Heart J

    (1987)
  • P Mathisen et al.

    Comparative study of atrial peptides ANF(1-98) and ANF(99-126) as diagnostic markers of atrial distension in patients with cardiac disease

    Scand J Lab Invest

    (1993)
  • K Swedberg et al.

    Hormones regulating cardiovascular function in patients with severe congestive heart failure and their relation to mortality

    Circulation

    (1990)
  • C Hall et al.

    The plasma concentration of N-terminal proatrial natriuretic factor ANF(1-98) is related to prognosis in severe heart failure

    Clin Cardiol

    (1994)
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    From the Departments of aInternal Medicine and Cardiology of Östra University Hospital (Göteborg), cVarberg, dMölndal, e Uddevalla, and fLidköping; and the bInstitute for Surgical Research, Oslo.

    ☆☆

    Reprint requests: Björn Hornestam, MD, Division of Cardiology, Department of Internal Medicine, Sahlgrenska University Hospital, S- 413 45 Göteborg, Sweden.

    4/1/89191

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