Blood Peptide MR-proANP Predicts Whether Heart Rhythm Will Stay Normal After Cardioversion

Prospective, multicenter, observational study enrolling 61 patients with persistent atrial fibrillation and preserved left ventricular function (LVEF ≥45%) undergoing electrical cardioversion from December 2017 to March 2019. MR-proANP, sST2, and BNP were measured in peripheral venous blood before cardioversion. Patients were followed for 12 months, with AF recurrence defined as ECG-documented AF or any episode >30 seconds on 24-hour Holter monitoring. Registered at ClinicalTrials.gov (NCT03351816).

Electrical cardioversion is a common treatment for atrial fibrillation, but up to half of patients experience recurrence. A simple blood test that predicts who will and won't maintain normal rhythm could help doctors make better treatment decisions — potentially sparing patients an ineffective procedure or prompting earlier consideration of alternatives like catheter ablation.

Natriuretic peptides like BNP are already used widely in heart failure management. This study suggests that MR-proANP — a more stable fragment of the atrial natriuretic peptide — may have a specific role in predicting AF outcomes. As the field moves toward personalized AF management, biomarker-guided decision-making could help select the best rhythm control strategy for each patient.

The study is small (n=61) and observational, limiting its statistical power and the strength of its conclusions. Only patients with preserved LVEF were included, so findings may not apply to those with reduced heart function. The single MR-proANP cutoff needs validation in larger, independent cohorts before clinical adoption. The 12-month follow-up may miss late recurrences.