Can BNP Levels After Cardioversion Predict Whether Atrial Fibrillation Will Return? | Research

The takeaway

BNP levels measured 30 minutes after cardioversion—but not before—predicted early recurrence of atrial fibrillation.

30-minute BNP
Post-cardioversion BNP predicted early AF recurrence, while baseline BNP did not

What the researchers found

Post-cardioversion BNP at 30 minutes, not baseline BNP, predicted early AF recurrence. Higher BNP was associated with worse diastolic dysfunction.

Why it matters

Predicting which AF patients will relapse after cardioversion could help guide more targeted treatment decisions.

The numbers in context

- 31 patients with persistent AF; 28 successfully cardioverted

- 30-minute BNP in AF recurrence group: 318 ± 39.7 pg/mL

- 30-minute BNP in maintained rhythm group: 153 ± 11.9 pg/mL (p=0.05)

- Baseline BNP: not predictive of recurrence

- BNP correlated with heart rate and E/Em ratio

How the study worked

Prospective observational study of 31 patients with persistent AF, with echocardiography and BNP at multiple time points.

Who was studied

N=31 patients with persistent atrial fibrillation undergoing direct-current cardioversion. Single center, prospective study with 1-month follow-up.

What this study cannot tell us

Very small sample size (31 patients). Single center. Short follow-up (1 month). Results need validation in larger cohorts.

How to read the evidence

Small prospective observational study. Low evidence level; hypothesis-generating.

When this study was published

Published in 2025.

The bigger picture

Timing of biomarker measurement matters. Post-procedural BNP may capture dynamic cardiac stress that predicts outcomes better than baseline values.

Questions still open

Would a larger study confirm the predictive value of post-cardioversion BNP?
Could this approach help decide between cardioversion and catheter ablation?

Common questions

Does BNP predict atrial fibrillation recurrence after cardioversion?

Baseline BNP did not predict recurrence, but BNP measured 30 minutes after the procedure was significantly higher in patients whose AF returned early.

Why does post-procedure BNP matter more than baseline?

The 30-minute measurement may capture the heart's acute stress response to rhythm conversion, revealing underlying structural issues that promote recurrence.

Read the original research

Association of plasma BNP levels at different times with cardioversion success, maintenance of sinus rhythm and severity of diastolic dysfunction in patients with atrial fibrillation.

Cardiovascular journal of Africa, 36(1), 6-11

View on PubMed ↗Publisher’s paper ↗

Citation

Ozturk, Ali; Okan, Taha. (2025). Association of plasma BNP levels at different times with cardioversion success, maintenance of sinus rhythm and severity of diastolic dysfunction in patients with atrial fibrillation.. Cardiovascular journal of Africa, 36(1), 6-11. https://doi.org/10.5830/CVJA-2024-009