Elevated MR-proANP levels before electrical cardioversion independently predicted atrial fibrillation recurrence within one year, with a positive predictive value of 83.3%.
83.3% positive predictive valueMR-proANP above 311.5 pmol/L correctly predicted AF recurrence after cardioversion in more than 4 out of 5 cases
What the researchers found
MR-proANP above 311.5 pmol/L was the sole independent predictor of AF recurrence after electrical cardioversion, with a hazard ratio of 4.74 (95% CI: 1.59–14.07) and a positive predictive value of 83.3%.
Patients with recurrent AF had significantly higher pre-cardioversion MR-proANP levels (314.45 [210.90–342.50] vs. 214.50 [138.97–264.72] pmol/L, p<0.05). Neither sST2 nor BNP independently predicted AF recurrence. Sinus rhythm was successfully restored in 83.6% (51/61) of patients initially.
Why it matters
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.
How the study worked
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).
What this study cannot tell us
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.
How to read the evidence
This is a prospective, multicenter observational study registered as a clinical trial. The design is relatively strong, but the small sample size (61 patients) means the findings need replication before clinical adoption.
When this study was published
Published in 2025, this study is very recent and contributes to the active search for biomarkers that can personalize AF rhythm management.
The bigger picture
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.
Questions still open
- Does MR-proANP also predict AF recurrence after catheter ablation, not just electrical cardioversion?
- Would serial MR-proANP measurements during follow-up provide additional prognostic value?
- Can MR-proANP be combined with clinical risk scores to improve prediction accuracy beyond either approach alone?
Common questions
What is MR-proANP and why is it found in the blood?
Why does atrial fibrillation come back after electrical cardioversion?
Read the original research
MR-proANP, sST2, BNP and sinus rhythm maintenance 1 year after electrical cardioversion for atrial fibrillation.
BMC cardiovascular disorders, 25(1), 640
Citation
Badoz, Marc; Serzian, Guillaume; Favoulet, Baptiste; Sellal, Jean-Marc; De Chillou, Christian; Laurent, Gabriel; Ecarnot, Fiona; Bardonnet, Karine; Seronde, Marie-France; Schiele, François; Meneveau, Nicolas. (2025). MR-proANP, sST2, BNP and sinus rhythm maintenance 1 year after electrical cardioversion for atrial fibrillation.. BMC cardiovascular disorders, 25(1), 640. https://doi.org/10.1186/s12872-025-05052-5