atrial-natriuretic-factor and Atrial-Fibrillation

Natriuretic peptides (NPs) are the principal expression products of the endocrine function of the heart. They exert several beneficial effects, mostly mediated through guanylate cyclase-A coupled receptors, including natriuresis, diuresis, vasorelaxation, blood volume and blood pressure reduction, and regulation of electrolyte homeostasis. As a result of their biological functions, NPs counterbalance neurohormonal dysregulation in heart failure and other cardiovascular diseases. NPs have been also validated as diagnostic and prognostic biomarkers in cardiovascular diseases such as atrial fibrillation, coronary artery disease, and valvular heart disease, as well as in the presence of left ventricular hypertrophy and severe cardiac remodeling. Serial measurements of their levels may be used to contribute to more accurate risk stratification by identifying patients who are more likely to experience death from cardiovascular causes, heart failure, and cardiac hospitalizations and to guide tailored pharmacological and non-pharmacological strategies with the aim to improve clinical outcomes. On these premises, multiple therapeutic strategies based on the biological properties of NPs have been attempted to develop new targeted cardiovascular therapies. Apart from the introduction of the class of angiotensin receptor/neprilysin inhibitors to the current management of heart failure, novel promising molecules including M-atrial natriuretic peptide (a novel atrial NP-based compound) have been tested for the treatment of human hypertension with promising results. Moreover, different therapeutic strategies based on the molecular mechanisms involved in NP regulation and function are under development for the management of heart failure, hypertension, and other cardiovascular conditions.

Topics: Atrial Fibrillation; Atrial Natriuretic Factor; Heart; Heart Failure; Humans; Hypertension; Natriuretic Peptide, Brain; Natriuretic Peptides

ANP is mainly synthesized by the atria, and upon excretion, it serves two primary purposes: vasodilation and increasing the renal excretion of sodium and water. The understanding of ANP's role in cardiac systems has improved considerably in recent decades. This review focuses on several studies demonstrating the importance of analyzing the regulations between the endocrine and mechanical function of the heart and emphasizes the effect of ANP, as the primary hormone of the atria, on atrial fibrillation (AF) and related diseases. The review first discusses the available data on the diagnostic and therapeutic applications of ANP and then explains effect of ANP on heart failure (HF) and atrial fibrillation (AF) and vice versa, where tracking ANP levels could lead to understanding the pathophysiological mechanisms operating in these diseases. Second, it focuses on conventional treatments for AF, such as cardioversion and catheter ablation, and their effects on cardiac endocrine and mechanical function. Finally, it provides a point of view about the delayed recovery of cardiac mechanical and endocrine function after cardioversion, which can contribute to the occurrence of acute heart failure, and the potential impact of restoration of the sinus rhythm by extensive ablation or surgery in losing ANP-producing sites. Overall, ANP plays a key role in heart failure through its effects on vasodilation and natriuresis, leading to a decrease in the activity of the renin-angiotensin-aldosterone system, but it is crucial to understand the intimate role of ANP in HF and AF to improve their diagnosis and personalizing the patients' treatment.

Topics: Amyloidosis; Atrial Fibrillation; Atrial Natriuretic Factor; Heart Atria; Heart Failure; Humans

Catheter ablation (CA) has become the first-line treatment strategy for atrial fibrillation (AF) but remains with a substantial recurrence rate. The aim of this meta-analysis was to determine the association between baseline natriuretic peptide levels and AF recurrence after CA.. We systematically searched PubMed, EMBASE, Web of Science, and Wiley-Cochrane Library for relevant studies published up until May 2022. Overall effect analysis and subgroup analysis were performed with Review Manager software.. Finally, 61 studies that met the inclusion criteria were included in our meta-analysis. Compared with the nonrecurrence group, the recurrence group had increased baseline level of atrial natriuretic peptide (ANP) (standardized mean difference [SMD] = 0.39, 95% confidence interval [CI]: 0.21-0.56), brain natriuretic peptide (BNP) (SMD = 0.51, 95% CI: 0.31-0.71), N-terminal pro-BNP (SMD = 0.71, 95% CI: 0.49-0.92), and midregional N-terminal pro-ANP (SMD = 0.91, 95% CI: 0.27-1.56).. Increased baseline natriuretic peptide levels, including ANP, BNP, N-terminal pro-BNP, and midregional N-terminal pro-ANP, are associated with a higher risk of AF recurrence after CA. Nonetheless, further studies are needed to elucidate the predictive value of baseline natriuretic peptides in AF patients undergoing CA.

Topics: Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Catheter Ablation; Humans; Natriuretic Peptide, Brain; Natriuretic Peptides; Recurrence; Treatment Outcome; Vasodilator Agents

Investigations into the mixed muscle-secretory phenotype of cardiomyocytes from the atrial appendages of the heart led to the discovery that these cells produce, in a regulated manner, two polypeptide hormones - the natriuretic peptides - referred to as atrial natriuretic factor or atrial natriuretic peptide (ANP) and brain or B-type natriuretic peptide (BNP), thereby demonstrating an endocrine function for the heart. Studies on the gene encoding ANP (NPPA) initiated the field of modern research into gene regulation in the cardiovascular system. Additionally, ANP and BNP were found to be the natural ligands for cell membrane-bound guanylyl cyclase receptors that mediate the effects of natriuretic peptides through the generation of intracellular cGMP, which interacts with specific enzymes and ion channels. Natriuretic peptides have many physiological actions and participate in numerous pathophysiological processes. Important clinical entities associated with natriuretic peptide research include heart failure, obesity and systemic hypertension. Plasma levels of natriuretic peptides have proven to be powerful diagnostic and prognostic biomarkers of heart disease. Development of pharmacological agents that are based on natriuretic peptides is an area of active research, with vast potential benefits for the treatment of cardiovascular disease.

Topics: Animals; Atrial Appendage; Atrial Fibrillation; Atrial Natriuretic Factor; Atrial Remodeling; Biomarkers; Cyclic GMP; Diabetes Mellitus; Fibrosis; Gene Expression Regulation, Developmental; Heart Atria; Heart Failure; Humans; Hypertension; Lipid Metabolism; Metabolic Syndrome; Mice; Myocardium; Myocytes, Cardiac; Natriuretic Peptide, Brain; Obesity; Peptide Fragments; Prognosis; Protein Processing, Post-Translational; Pulmonary Arterial Hypertension; Receptors, Guanylate Cyclase-Coupled; Secretory Vesicles; Ventricular Remodeling; Water-Electrolyte Balance

Background Atrial fibrillation ( AF ) is a common arrhythmia seen in clinical practice. Occasionally, no common risk factors are present in patients with this arrhythmia. This suggests the potential underlying role of genetic factors associated with predisposition to developing AF . Methods and Results We conducted a comprehensive review of the literature through large online libraries, including PubMed. Many different potassium and sodium channel mutations have been discussed in their relation to AF . There have also been non-ion channel mutations that have been linked to AF . Genome-wide association studies have helped in identifying potential links between single-nucleotide polymorphisms and AF . Ancestry studies have also highlighted a role of genetics in AF . Blacks with a higher percentage of European ancestry are at higher risk of developing AF . The emerging field of ablatogenomics involves the use of genetic profiles in their relation to recurrence of AF after catheter ablation. Conclusions The evidence for the underlying role of genetics in AF continues to expand. Ultimately, the role of genetics in risk stratification of AF and its recurrence is of significant interest. No established risk scores that are useful in clinical practice are present to date.

Topics: Atrial Fibrillation; Atrial Natriuretic Factor; Calcium; Catheter Ablation; Genetic Association Studies; Genetic Predisposition to Disease; Genome-Wide Association Study; Homeostasis; Humans; Lamins; Mutation; Neovascularization, Physiologic; Nuclear Pore; Pedigree; Potassium Channels; Sodium Channels

Atrial natriuretic peptide (carperitide) is used to treat heart failure in Japan, while brain natriuretic peptide (nesiritide) is employed in Europe/USA. Patients undergoing cardiac surgery have a complex underlying pathologic state that features increased levels of neurohumoral factors due to activation of the renin-angiotensin-aldosterone system and/or increased sympathetic activity. We considered that perioperative administration of carperitide could be beneficial for cardiac surgery patients, and we have conducted clinical investigations of its use. This article reviews the effects of natriuretic peptides in cardiac surgery patients based on our experience and on previous reports about perioperative management with carperitide or nesiritide.

Topics: Atrial Fibrillation; Atrial Natriuretic Factor; Cardiac Surgical Procedures; Cardiotonic Agents; Humans; Perioperative Care; Pulmonary Circulation

The left atrium plays an important role in the maintenance of cardiovascular and neurohumoral homeostasis in heart failure. However, with progressive left ventricular dysfunction, left atrial (LA) dilation and mechanical failure develop, which frequently culminate in atrial fibrillation. Moreover, LA mechanical failure is accompanied by LA endocrine failure [deficient atrial natriuretic peptide (ANP) processing-synthesis/development of ANP resistance) and LA regulatory failure (dominance of sympathetic nervous system excitatory mechanisms, excessive vasopressin release) contributing to neurohumoral overactivity, vasoconstriction, and volume overload (global LA failure). The purpose of the present review is to describe the characteristics and emphasize the clinical significance of global LA failure in patients with heart failure.

Topics: Atrial Fibrillation; Atrial Function, Left; Atrial Natriuretic Factor; Heart Atria; Heart Failure; Humans; Sympathetic Nervous System; Vasoconstriction; Vasopressins; Ventricular Dysfunction, Left

Since the discovery of atrial natriuretic peptide (ANP) in 1981, significant progress has been made in understanding the mechanism of its release and its role in salt and water balance in the body. It has also become clear that ANP plays a key role in cardiac electrophysiology, modulating the autonomic nervous system and regulating the function of cardiac ion channels. The clinical importance of this role was established when mutations in NPPA, the gene encoding ANP, were identified as a cause of familial atrial fibrillation. This review examines our current understanding of the electrophysiological effects of ANP, and their physiological relationship to clinical studies linking ANP and atrial fibrillation.

Topics: Action Potentials; Atrial Fibrillation; Atrial Natriuretic Factor; Autonomic Nervous System; Cardiac Electrophysiology; Heart; Humans; Time Factors

Structural remodelling occurring before, due to the underlying heart disease, and during atrial fibrillation (AF) sets the stage for permanent AF. Current therapy in AF aims to maintain sinus rhythm in symptomatic patients, but outcome is unfortunately poor. Stretch of the atria is a main contributor to atrial remodelling. In this review, we describe different aspects of structural remodelling as seen in animal models and in patients with AF, including atrial enlargement, cellular hypertrophy, dedifferentiation, fibrosis, apoptosis, and loss of contractile elements. In the second part, we describe downstream signals of mechanical stretch and their contribution to AF and structural remodelling. Ultimately, knowledge of mechanisms underlying structural remodelling may help to identify new pharmacological targets for AF prevention.

Topics: Animals; Apoptosis; Atrial Fibrillation; Atrial Natriuretic Factor; Cardiomegaly; Cell Differentiation; Fibrosis; Heart Atria; Humans; Oxidative Stress; Renin-Angiotensin System

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether atrial natriuretic peptide (ANP) or brain natriuretic peptide (BNP) could be a useful alternative diuretic for patients post cardiac surgery. Altogether more than 250 papers were found using the reported search, of which eight RCTs represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that the RCTs consistently showed a diuretic effect with increased creatinine clearance, and increased urine volume and reduced usage of conventional diuretics. Lower urea and creatinine levels were also found postoperatively and also reduced decreases in glomerular filtration rate compared to placebo, both in studies of patients with preoperatively normal renal function and those who had impaired function. In addition, two studies found a reduction in the incidence of AF, and renin/aldosterone levels were lower. The NAPA trial of 272 CABG patients with LV dysfunction was the only study to show a shorter ICU stay and reduced early mortality with nesiritide compared to placebo.

Topics: Anti-Arrhythmia Agents; Atrial Fibrillation; Atrial Natriuretic Factor; Benchmarking; Cardiac Surgical Procedures; Creatinine; Diuretics; Evidence-Based Medicine; Glomerular Filtration Rate; Humans; Intensive Care Units; Kidney Diseases; Length of Stay; Natriuretic Peptide, Brain; Treatment Outcome; Urea

Natriuretic peptide (NP) levels (B-type natriuretic peptide [BNP] and N-terminal proBNP) are now widely used in clinical practice and cardiovascular research all over the world and have been incorporated into many cardiovascular guidelines for heart failure (HF). The roles of NP levels are evolving rapidly not only in diagnosis, therapy monitoring, and risk stratification of HF, but also in differential diagnosis of acute dyspnea, predicting death and rehospitalization in HF patients. NP assays have been applied in permanent cardiac pacing in recent years, whereas it is still not well known how NP levels change and whether NP levels can predict HF in permanent cardiac pacing. Therefore, this article reviews the role of NP levels in permanent cardiac pacing, mainly including NP changes in different cardiac pacing modes and cardiac resynchronization therapy.

Topics: Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Humans; Natriuretic Peptide, Brain; Outcome Assessment, Health Care; Reproducibility of Results; Sensitivity and Specificity; Treatment Outcome; Ventricular Dysfunction, Left

Systolic heart failure (HF) is a progressive disorder that often begins with asymptomatic left ventricular (LV) systolic dysfunction and culminates in symptoms from fluid overload and poor end-organ perfusion. The progression to symptomatic HF is accompanied by marked activation of neurohormonal and cytokine systems, as well as a series of adaptive LV anatomical and functional changes, collectively referred to as LV remodelling. However, the mechanisms underlying symptom appearance have not been delineated and the weight of experimental and clinical evidence suggests that the development of symptomatic HF occurs independently of the haemodynamic status of the patient. The left atrium is a muscular chamber strategically located between the left ventricle and the pulmonary circulation with important mechanical function (modulation of LV filling), which is closely coupled with its endocrine (atrial natriuretic peptide synthesis and secretion) and regulatory (contribution to the control of sympathetic activity and vasopressin release) functions. In this narrative review we provide evidence supporting the concept that left atrial dilation and systolic dysfunction (left atrial remodelling) contributes to the progression of asymptomatic LV dysfunction to chronic symptomatic systolic HF as it is a prerequisite for the development of the pulmonary congestion and marked neuronhormoral activity that characterize the symptomatic state.

Topics: Atrial Fibrillation; Atrial Function, Left; Atrial Natriuretic Factor; Disease Progression; Heart Failure, Systolic; Humans; Pressoreceptors; Ventricular Dysfunction, Left; Ventricular Remodeling

The Losartan Intervention For Endpoint reduction in hypertension (LIFE) study is the first, and, so far, the only endpoint trial in patients with hypertension and left ventricular hypertrophy (LVH) to show a divergent therapeutic outcome of one treatment modality over another with equivalent blood pressure control. The purpose of this article is to review post hoc sub-analyses of LIFE study data and other clinical studies that offer some insight into possible treatment-related differences contributing to the superior stroke outcome of losartan versus atenolol beyond blood pressure reduction.. Relevant randomized clinical trials and review articles were identified through a MEDLINE search of English-language articles published between 1990 and 2006 using the search terms losartan, atenolol, LIFE, hypertension, and LVH. Articles describing major clinical studies, new data, or mechanisms pertinent to the LIFE study were selected for review.. Differences in blood pressure or in the distribution of add-on medications were not evident between study groups in the LIFE study. Thus, the observed outcomes benefits favoring losartan may involve other possible mechanisms, including differential effects of losartan and atenolol on LVH regression, left atrial diameter, atrial fibrillation, brain natriuretic peptide, vascular structure, thrombus formation/platelet aggregation, serum uric acid, albuminuria, new-onset diabetes, and lipid metabolism. Alternative explanations for the LIFE study findings have also been put forward, including the choice of atenolol as an appropriate active comparator and differential effects between treatment groups on central pulse pressure. Additional clinical trials are needed to determine if the beneficial effects of losartan seen in LIFE are shared by other inhibitors of the renin-angiotensin system.. Sub-analyses of the LIFE study data suggest that losartan's stroke benefit may arise from a mosaic of mechanisms rather than a single action. Further studies are expected to continue to delineate the mechanisms of differential responses to treatments in LIFE.

Topics: Adrenergic beta-Antagonists; Angiotensin II Type 1 Receptor Blockers; Antihypertensive Agents; Atenolol; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Blood Pressure; Cardiovascular Agents; Cohort Studies; Drug Utilization; Endothelium, Vascular; Follow-Up Studies; Heart Atria; Humans; Hypertension; Hypertrophy, Left Ventricular; Losartan; Models, Biological; Myocardial Infarction; Natriuretic Peptide, Brain; Peptide Fragments; Platelet Aggregation; Platelet Aggregation Inhibitors; Protein Precursors; Randomized Controlled Trials as Topic; Research Design; Risk; Risk Factors; Stroke; Thrombosis; Treatment Outcome

Topics: Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Humans; Natriuretic Peptide, Brain; Predictive Value of Tests; Prognosis

This review focuses on the relation between atrial fibrillation (AF) and atrial natriuretic peptide (ANP). ANP is produced by the atria secondary to atrial stretch. By causing atrial stretch, acute AF leads to an increase in plasma ANP concentration, which serves to normalize haemodynamics through natriuresis and vasodilation. However, data have been reported suggesting that prolonged AF, by inflicting structural atrial damage, is associated with a reduced capacity by the atria to produce ANP. An inverse relation was thus demonstrated between the duration of AF and plasma ANP concentration. In addition, a reduced ANP response to exercise has been shown to be predictive of unsuccessful cardioversion of AF to sinus rhythm. Finally, ANP has also been shown to predict outcome after a maze operation. Outcome was poor when preoperative plasma ANP concentration was low. Moreover, a high atrial collagen content, as a measure of atrial degeneration, correlated with low ANP. These data indicate that ANP may serve as a marker of atrial integrity, which may help in selecting AF patients for therapeutic interventions.

Topics: Atrial Fibrillation; Atrial Natriuretic Factor; Humans; Myocytes, Cardiac; Time Factors

Percutaneous left atrial appendage closure is an alternative treatment for stroke and systemic thromboembolism risk reduction in non-valvular atrial fibrillation (AF). However, the neurohormonal impact of epicardial exclusion of the left atrial appendage (LAA) with the LARIAT procedure is unknown. Evaluation of changes in atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) levels in AF patients underwent percutaneous LAA suture ligation. Sixty six patients underwent successfully percutaneous LAA suture ligation using LARIAT device. The level of ANP and BNP was measured before and 3 months after procedure. Mean ANP level before procedure was 249 ± 77 pg/mL (range from 95 pg/mL to 503 pg/mL) and mean BNP level was 481 ± 517 pg/mL (range from 34 pg/mL to 2508 pg/mL). Three months after procedure mean ANP level was 249 ± 79 pg/mL (range from 98 pg/mL to 492 pg/mL) and mean BNP level was 495 ± 526 pg/mL (range from 52 pg/mL to 2420 pg/mL). At 3 months follow up after percutaneous LAA suture ligation there were no significant differences in ANP and BNP levels.

Topics: Adult; Aged; Aged, 80 and over; Atrial Appendage; Atrial Fibrillation; Atrial Natriuretic Factor; Female; Humans; Ligation; Male; Middle Aged; Natriuretic Peptide, Brain; Sutures

The left atrial appendage (LAA) represents both a predisposing source of thrombus formation and of neuro-humoral haemostasis. This study aims to evaluate changes of biomarker expression before and after successful percutaneous closure of the LAA. Patients with atrial fibrillation and contraindication for oral anticoagulant therapy were enrolled. Blood samples were taken within 24 hours before (T1) and at least 6 months (mid-term) (T2) after successful implantation of LAA occlusion devices. Blood levels of high sensitivity troponin I and T (hsTnI, hsTnT), aminoterminal pro-brain natriuretic peptide (NT-proBNP) and mid-regional pro-atrial natriuretic peptide (MR-proANP) were evaluated at both time points. A total of 42 patients with successful percutaneous LAA closure were included. Median mid-term follow-up was of 183 days. HsTnT, hsTnI and NT-proBNP did not show any significant differences over time. Serum levels of MR-proANP increased significantly between immediate pre-intervention (T1: median = 245.7 pmol/l, IQR 155.8-361.3 pmol/l) and at mid-term follow-up (T2: median = 254 pmol/l, IQR 183.4-396.4 pmol/l) (p = 0.037). These results indicate, that percutaneous LAA closure affects neuro-humoral haemostasis by increasing MR-proANP serum levels at mid-term follow-up.

Topics: Aged; Aged, 80 and over; Atrial Appendage; Atrial Fibrillation; Atrial Natriuretic Factor; Cardiac Surgical Procedures; Female; Heart Atria; Humans; Male; Natriuretic Peptide, Brain; Peptide Fragments; Prospective Studies; Time Factors; Treatment Outcome; Troponin I; Troponin T

To investigate the effects of catheter ablation and rate control strategies on cardiac and inflammatory biomarkers in patients with heart failure and persistent atrial fibrillation (AF).. Patients were recruited from the ARC-HF trial (catheter Ablation vs Rate Control for management of persistent AF in Heart Failure, NCT00878384), which compared ablation with rate control for persistent AF in heart failure. B-type natriuretic peptide (BNP), midregional proatrial natriuretic peptide (MR-proANP), apelin, and interleukin-6 (IL-6) were assayed at baseline, 3 months, 6 months, and 12 months. The primary end point, analyzed per-protocol, was changed from baseline at 12 months.. Of 52 recruited patients, 24 ablation and 25 rate control subjects were followed to 12 months. After 1.2 ± 0.5 procedures, sinus rhythm was present in 22 (92%) ablation patients; under rate control, rate criteria were achieved in 23 (96%) of 24 patients remaining in AF. At 12 months, MR-proANP fell significantly in the ablation arm (-106.0 pmol/L, interquartile range [IQR] -228.2 to -60.6) compared with rate control (-28.7 pmol/L, IQR -69 to +9.5, P = 0.028). BNP showed a similar trend toward reduction (P = 0.051), with no significant difference in apelin (P = 0.13) or IL-6 (P = 0.68). Changes in MR-proANP and BNP correlated with peak VO2 and ejection fraction, and MR-proANP additionally with quality-of-life score.. Catheter ablation, compared with rate control, in patients with heart failure and persistent AF was associated with significant reduction in MR-proANP, which correlated with physiological and symptomatic improvement. Ablation-based rhythm control may induce beneficial cardiac remodeling, unrelated to changes in inflammatory state. This may have prognostic implications, which require confirmation by event end point studies.

Topics: Anti-Arrhythmia Agents; Apelin; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Cardiac Pacing, Artificial; Catheter Ablation; Chronic Disease; Female; Heart Failure; Humans; Intercellular Signaling Peptides and Proteins; Interleukin-6; Male; Middle Aged; Natriuretic Peptide, Brain; Outcome Assessment, Health Care; Reproducibility of Results; Sensitivity and Specificity; Treatment Outcome

Biomarker activation in atrial fibrillation (AF) has been widely studied, but the immediate effect of AF initiation remains unclear. We studied the effect of AF initiation on 2 cardiac biomarkers: the N-terminal fragment of the proB-type natriuretic peptide (NT-proBNP), the midregional fragment of the N-terminal of pro-atrial natriuretic peptide (MR-proANP), and 2 extracardiac biomarkers-the copeptin and the midregional portion of proadrenomedullin (MR-proADM).. AF is a strong stimulus that results in immediate activation of different biomarkers.. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01553045.

Topics: Analysis of Variance; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Catheter Ablation; Female; Fluoroscopy; Glycopeptides; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Operative Time; Peptide Fragments

Occurrence of atrial fibrillation after cardiac surgery is associated with long-term mortality. We investigated whether infusion of human atrial natriuretic peptide (carperitide) could prevent postoperative atrial fibrillation.. A total of 668 patients who underwent isolated coronary artery bypass grafting were randomized to receive infusion of carperitide or physiological saline from the initiation of cardiopulmonary bypass. Patients were monitored continuously for 1 week after surgery to detect atrial fibrillation. The risk factors were investigated by Cox proportional hazard model. Postoperative atrial fibrillation occurred in 41 of 335 patients (12.2%) from the carperitide group versus 110 of 333 patients (32.7%) from the placebo group (P<0.0001). Postoperative levels of angiotensin-II, aldosterone, creatine kinase MB isoenzyme, human heart fatty acid-binding protein, and brain natriuretic peptide were all significantly lower in the carperitide group. The risk factors for postoperative atrial fibrillation by the Cox proportional hazard model were an age ≥70 years, emergency surgery, preoperative aldosterone level >150 ng/mL, preoperative nonuse of angiotensin receptor antagonists, preoperative use of calcium antagonists, postoperative nonuse of β-blockers, postoperative nonuse of aldosterone blockers, and nonuse of carperitide.. -Perioperative carperitide infusion reduced the occurrence of postoperative atrial fibrillation. Accordingly, carperitide could be a useful option for preventing postoperative atrial fibrillation.. -URL: http://www.umin.ac.jp. Unique Identifier: UMIN000003958.

Topics: Anti-Arrhythmia Agents; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Cardiopulmonary Bypass; Chi-Square Distribution; Coronary Artery Bypass; Coronary Artery Disease; Disease-Free Survival; Double-Blind Method; Humans; Infusions, Parenteral; Japan; Kaplan-Meier Estimate; Proportional Hazards Models; Risk Factors; Time Factors; Treatment Outcome

Restoration of the mechanical and endocrine functions of the left atrium remains controversial after electrical cardioversion treatment for persistent atrial fibrillation. The objective of the prospective study was to describe the recovery of the endocrine and mechanical functions of the left atrium.. Evaluation of left atrium recovery after electrical cardioversion by the new speckle-tracking echocardiography technique and proANP measurement.. Twenty patients suffering from persistent atrial fibrillation with no alteration of left ventricular ejection fraction were prospectively evaluated at baseline and then one month later by echocardiography, measuring left atrial volume and left atrial deformation (MPALS), as well as the proANP and BNP concentrations. One month after cardioversion 10 patients remained in sinus rhythm and 10 showed recurrent atrial fibrillation. No significant differences between the two groups in terms of clinical, echocardiographic and endocrine parameters were observed at baseline evaluation. We observed a significant reduction of left atrial volume only in the sinus group, whereas restoration of the left atrial deformation was only partial (18%) in that group. By contrast, we registered no significant changes in ANP concentration at one month in either the sinus or the atrial fibrillation groups.. These results suggest that restoration of left atrium mechanical function is only partial one month after treatment of persistent atrial fibrillation by electrical cardioversion, whereas a significant reduction of left atrial volume was noted, explaining the remaining high level of ANP in the sinus group.

Topics: Aged; Atrial Fibrillation; Atrial Function, Left; Atrial Natriuretic Factor; Electric Countershock; Endocrine System; Female; Heart Atria; Humans; Male; Pilot Projects; Recovery of Function; Ultrasonography

We previously reported that patients with preoperative B-type natriuretic peptide levels of 30 pg/mL or more have increased risk of postoperative atrial fibrillation after pulmonary resection. This study evaluated the effects of human atrial natriuretic peptide on postoperative atrial fibrillation in patients undergoing pulmonary resection for lung cancer.. A prospective, randomized study was conducted with 40 patients who had preoperative elevated B-type natriuretic peptide (≥ 30 pg/mL) and underwent a scheduled pulmonary resection for lung cancer. Results were compared between patients who received low-dose human atrial natriuretic peptide and those who received a placebo. The primary end point was the incidence of postoperative atrial fibrillation during the first 4 days after surgery.. The incidence of postoperative atrial fibrillation was significantly lower in the human atrial natriuretic peptide group than in the placebo group (10% vs 60%; P < .001). Patients in the human atrial natriuretic peptide group also showed significantly lower white blood cell counts and C-reactive protein levels after surgery.. Continuous infusion of low-dose human atrial natriuretic peptide during lung cancer surgery had a prophylactic effect against postoperative atrial fibrillation after pulmonary resection in patients with preoperative elevation of B-type natriuretic peptide levels. A larger sample size is needed to establish the safety and efficacy of this intervention.

Topics: Aged; Aged, 80 and over; Analysis of Variance; Anti-Arrhythmia Agents; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; C-Reactive Protein; Chi-Square Distribution; Double-Blind Method; Female; Hemodynamics; Humans; Infusions, Parenteral; Japan; Leukocyte Count; Lung Neoplasms; Male; Middle Aged; Natriuretic Peptide, Brain; Placebos; Pneumonectomy; Time Factors; Treatment Outcome; Up-Regulation

Atrial fibrillation (AF) is a common arrhythmia; its most prevalent and devastating complication is stroke. A delay of AF onset >48 h is believed to be clinically significant. Mid-regional pro A-type natriuretic peptide (MR-proANP) could be of interest in the identification of the time from onset of AF to presentation.. We measured MR-proANP plasma concentration at presentation in consecutive patients in whom onset of AF was determined, without evidence of concomitant acute heart failure.. Forty-seven patients were included. Patients with an AF onset <48 h (n=19) had decreased MR-proANP concentrations versus patients with onset >48 h (144.0 [129.2-213.7] versus 321.7 [236.4-425.6] pmol/L, p<0.001); MR-proANP was the only independent variable associated with AF <48 h according to multivariate analysis. Area under the ROC curve for identify AF onset <48 h was 0.878 [95%CI 0.778-0.978].. MR-proANP concentration may reliably identify the time from onset of AF to presentation.

Topics: Aged; Aged, 80 and over; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Female; Heart Failure; Humans; Male; Middle Aged; Multivariate Analysis; Pilot Projects; Predictive Value of Tests; Stroke

Atrial fibrillation (AF) decreases quality of life and significantly increases risk of stroke, congestive heart failure and death. Atrial overload and stretch also result in increased production of natriuretic peptide type A (ANP). The biologically inactive prohormone NT-proANP is released to plasma in the same amounts as ANP but it has higher levels in the blood due to decreased degradation in vivo. In vitro degradation is also slower and NT-proANP may be an interesting alternative for ANP.. To evaluate NT-proANP plasma concentration in patients with persistent AF following successful cardioversion.. The study group consisted of 43 patients with persistent AF and normal left ventricular systolic function, who underwent successful electrical cardioversion (EC). The control group comprised 20 patients with sinus rhythm without a history of AF. Blood samples were collected twice, during visits 24 h before and after EC. All patients were also examined 30 days after the sinus rhythm recovery. The NT-proANP concentration was measured using an immunochemical method (ELISA).. Plasma NT-proANP concentration was significantly increased in patients with persistent AF compared to the control group (4.8 +/- 2.9 vs. 2.8 +/- 1.2 nmol/l, p = 0.004). Plasma NT-proANP level decreased significantly after successful cardioversion (to 3.2 +/- 2.4 nmol/l; p < 0.0001). There was no correlation between the baseline NT-proANP concentration and sinus rhythm maintenance during 30 days after EC.. Plasma NT-proANP concentration is higher in patients with persistent AF and normal left ventricular systolic function than in patients without arrhythmia. Sinus rhythm recovery due to EC leads to a decrease of plasma NT-proANP. The baseline NT-proANP level has no prognostic value for prediction of sinus rhythm maintenance during 30 days after EC.

Topics: Adult; Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Electric Countershock; Female; Humans; Male; Middle Aged; Treatment Outcome; Ultrasonography; Young Adult

This study included 68 patients (47 men, 21 women, mean age 69 years) in whom atrial fibrillation (AF) recurred immediately after electrical cardioversion (EC) was performed with no antiarrhythmic drugs. After administration of cibenzoline (Cib, 70 mg) or pilsicainide (Pil, 50 mg) on a randomized basis, all patients again underwent EC at the same energy as that prior to administration of antiarrhythmic drugs. We compared the efficacy of Cib (n = 35) and Pil (n = 33), and examined factors affecting successful cardioversion in patients treated with Cib. These patients were divided into a successful group (Group A) and an unsuccessful group (Group B). The success rate of EC at the same energy after intravenous Cib administration (77%) was significantly greater than that after intravenous Pil administration (42%) (p < 0.01). In patients treated with Cib, AF duration was significantly greater in Group B (55.8 ± 48.2 h) than in Group A (29.1 ± 17.0 h) (p < 0.05). Plasma concentrations of atrial natriuretic peptide (ANP) during AF and the ratio of ANP level during AF to that during sinus rhythm were also significantly greater in Group A (110.9 ± 69.7 pg/ml and 3.9 ± 2.8, respectively) than in Group B (58.2 ± 36.1 pg/ml and 1.8 ± 0.9, respectively) (both, p < 0.05). In patients treated with Pil, AF duration was also significantly greater in Group B (59.7 ± 44.6h) than in Group A (19.6 ± 21.7 h) (p < 0.05), and the ratio of ANP level during AF to that during sinus rhythm was significantly greater in Group A (3.5 ± 2.6) than in Group B (1.7 ± 0.9) (p < 0.05).. In patients with AF previously refractory to conventional EC, intravenous Cib administration was more effective in restoring sinus rhythm with EC than intravenous Pil administration. The capacity of ANP secretion during AF tachycardia may be a predictive indicator for the prevention of AF recurrence in electrically remodeled atria.

Topics: Aged; Anti-Arrhythmia Agents; Atrial Fibrillation; Atrial Natriuretic Factor; Electric Countershock; Female; Humans; Imidazoles; Injections, Intravenous; Lidocaine; Male

To study epicardial microwave ablation of concomitant atrial fibrillation and its effects on heart rhythm and atrial function during follow-up.. The study included 20 open-heart surgery patients with concomitant atrial fibrillation. Transthoracic echocardiography with flow and tissue Doppler recordings was performed preoperatively and at 6 months postoperatively. Blood samples were obtained preoperatively and postoperatively for analysis of atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and amino terminal precursor of brain natriuretic peptide (NT-proBNP).. Fourteen of 19 patients (74%) were in sinus rhythm with no antiarrhythmic drugs at 12 months. All patients in sinus rhythm had preserved left and right atrial-filling waves through atrioventricular valves during atrial contraction. Tissue velocity echocardiography on patients in sinus rhythm showed preserved atrial wall velocities, atrial strain, and atrial strain rate. Levels of natriuretic peptides tended to decrease in patients with stable sinus rhythm at one year compared to patients in atrial fibrillation.. Epicardial microwave ablation results in sinus rhythm in a majority of patients and seems to preserve atrial mechanical function.

Topics: Aged; Atrial Fibrillation; Atrial Function; Atrial Natriuretic Factor; Biomarkers; Catheter Ablation; Echocardiography, Doppler; Female; Heart Conduction System; Humans; Male; Microwaves; Middle Aged; Myocardial Contraction; Natriuretic Peptide, Brain; Peptide Fragments; Pericardium; Prospective Studies; Time Factors; Treatment Outcome

It has been reported that bepridil is as good as amiodarone in converting persistent atrial fibrillation (AF) to sinus rhythm (SR). The conversion effect of bepridil alone is not always satisfactory, however. The efficacy of pharmacological cardioversion by the combination of bepridil and a class Ic antiarrhythmic drug for persistent AF is studied.. The participants comprised 37 consecutive patients in whom pharmacological cardioversion was conducted to treat persistent AF (duration 22.5+/-29.6 months). Each patient first received a class Ia or Ic antiarrhythmic drug, then bepridil alone, then a combined therapy of bepridil at 200 mg/day with a class Ic antiarrhythmic drug at a routine dose. Unaccompanied use of any of the antiarrhythmic drugs achieved pharmacological cardioversion in 14 (38%) of the 37 patients (single therapy group), whereas SR was restored by combination of bepridil and a class Ic antiarrhythmic drug in 22 (combined therapy group) of the remaining 23 patients. The duration of AF was significantly longer in the combined therapy group than in the single therapy group (28.3+/-31.0 vs 7.3+/-4.1 months).. Combined therapy of bepridil and a class Ic antiarrhythmic drug is efficient for pharmacological cardioversion of refractory long-lasting persistent AF.

Topics: Adult; Aged; Anti-Arrhythmia Agents; Atrial Fibrillation; Atrial Natriuretic Factor; Bepridil; Drug Therapy, Combination; Electrocardiography; Female; Flecainide; Follow-Up Studies; Humans; Imidazoles; Lidocaine; Male; Middle Aged; Natriuretic Peptide, Brain; Sinoatrial Node; Treatment Outcome

The concentrations of atrial and brain natriuretic peptides (ANP and BNP) are elevated in patients with atrial fibrillation (AF), but the usefulness of their measurement before and after AF ablation has not been reported.. The concentrations of the natriuretic peptides were evaluated in 54 patients undergoing catheter ablation for drug-resistant paroxysmal and persistent AF without heart failure. Based on the outcome, the patients were divided into 2 groups: successful (n=42) or failure (n=12). All patients were asked to keep a log of the duration and frequency of their symptoms and underwent 24-h ECG monitoring at least once after the ablation. The plasma BNP and ANP concentrations, most of which were well below the heart failure range, exceeded the normal range in 69% and 26% of the patients, respectively. The BNP concentration decreased after ablation in the success group (49+/-43 to 27+/-28 pg/ml; p<0.05), however, it was unchanged in the failure group (46+/-35 to 70+/-37 pg/ml; p=0.46). A value of the DeltaBNP (BNP after ablation - BNP before ablation) of

Topics: Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Catheter Ablation; Drug Resistance; Electrocardiography, Ambulatory; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Predictive Value of Tests; Treatment Outcome

To evaluate whether the response to antiarrhythmic drug therapy in patients with paroxysmal atrial fibrillation affects the development of structural remodeling in the left atrium and ventricle.. This study included 230 patients (158 men and 72 women, mean age 67 +/- 11 years) in whom antiarrhythmic drug therapy was attempted for > or = 12 months to maintain sinus rhythm (mean follow-up period 45 +/- 27 months). The patients were divided into three groups according to the response to antiarrhythmic drug therapy: group A consisted of 78 patients without recurrence of atrial fibrillation, group B consisted of 87 patients with recurrence of atrial fibrillation and electrical and/or pharmacological cardioversion to restore sinus rhythm, and group C consisted of 65 patients with permanent conversion despite antiarrhythmic drug therapy.. In group A, left atrial dimension (LAD), left ventricular end-diastolic dimension (LVDd), and left ventricular ejection fraction (LVEF) did not change after antiarrhythmic drug therapy. In group B, LAD increased significantly after antiarrhythmic drug therapy (from 32.6 +/- 6.4 to 36.0 +/- 6.5 mm, p < 0.01), Whereas either LVDd or LVEF did not change after antiarrhythmic drug therapy. In group C, LAD increased significantly after antiarrhythmic drug therapy (from 37.3 +/- 7.0 to 40.5 +/- 7.9 mm, p < 0.01) and LVEF was significantly reduced after antiarrhythmic drug therapy (from 69.4 +/- 6.2% to 66.5 +/- 8.9%, p < 0.05). LVDd did not change after antiarrhythmic drug therapy. The plasma concentration of human atrial natriuretic peptide during sinus rhythm at the initiation of antiarrhythmic drug therapy in group A (30.5 +/- 26.7 pg/ml) was significantly lower than those in group B (48.0 +/- 49.7 pg/ml) and group C (49.7 +/- 39.5 pg/ml).. The development of structural remodeling in human myocardium can be prevented with antiarrhythmic drug therapy if sinus rhythm is maintained without recurrence of atrial fibrillation in patients with paroxysmal atrial fibrillation.

Topics: Aged; Aged, 80 and over; Anti-Arrhythmia Agents; Atrial Fibrillation; Atrial Natriuretic Factor; Echocardiography; Female; Humans; Male; Middle Aged; Recurrence; Ventricular Remodeling

Injury to the heart causes hematopoietic progenitor cells (HPCs) to migrate to the site of damage and to undergo cell differentiation. Studies suggest that myocardial progenitor cells invade atrial tissue. So far it is unclear, however, whether an atrial disease per se affects circulating HPCs.. Seventeen patients with persistent atrial fibrillation (persistAF), 12 with paroxysmal AF (paroxAF), and 17 matched patients with sinus rhythm (SR) were studied. HPCs (CD34+ and CD34+/CD117+) were quantified with the use of a fluorescence-activated cell sorter; stromal cell-derived factor-1alpha (SDF-1alpha), vascular endothelium growth factor (VEGF), and atrial natriuretic peptide (ANP) were determined by immunoassays. In patients with persistAF, blood samples were obtained before as well as 10 minutes, 24 hours, and 48 hours after electrical cardioversion. CD34+HPCs (AF, 7.0+/-2.3x10(3)/mL versus SR, 5.0+/-1.6x10(3)/mL; P<0.01) were increased during persistAF only. Highest SDF-1alpha levels were also observed during persistAF. Successful and unsuccessful cardioversion decreased CD34+HPCs temporarily (7.0+/-2.3x10(3)/mL versus 24 hours: 5.0+/-1.5x10(3)/mL; P<0.05). Forty-eight hours after successful cardioversion, SDF-1alpha and CD34+HPC levels started to decline, reaching control levels after 59+/-19 days. CD34+/CD117+ and VEGF levels, however, were increased by DC energy but not by AF. ANP levels correlated with CD34+HPC (r=0.76; P<0.01) and SDF-1alpha (r=0.56; P<0.01). HPCs from patients with AF had a greater tendency to differentiate into cells expressing (cardio)myocyte markers ANP and myocyte enhancer factor-2.. PersistAF appears to increase the potential of HPCs for (cardio)myogenesis. Restitution of CD34+HPC levels, mediated by SDF-1alpha and possibly ANP, occurs within several weeks after successful cardioversion.

Topics: Antigens, CD34; Atrial Fibrillation; Atrial Natriuretic Factor; Cell Count; Cells, Cultured; Chemokine CXCL12; Chemokines, CXC; DNA-Binding Proteins; Electric Countershock; Female; Hematopoietic Stem Cells; Humans; Interleukin-10; Interleukin-6; Male; MEF2 Transcription Factors; Middle Aged; Myogenic Regulatory Factors; Proto-Oncogene Proteins c-kit; Transcription Factors; Vascular Endothelial Growth Factor A

Assessment of left atrial appendage (LAA) function with transesophageal echocardiography is useful for detecting patients at high risk for thromboembolism as a result of atrial fibrillation (AF). A recent study reported that the atrium is the main source of brain natriuretic polypeptide (BNP) in AF patients without overt heart failure. The purpose of this study was to assess a possible relationship between LAA function and plasma BNP levels in nonvalvular AF.. Thirty-four consecutive patients with chronic nonvalvular AF (age, 69+/-9 years) underwent transesophageal echocardiography and plasma BNP measurement. Thirteen patients with a history of thromboembolism or echocardiographic evidence of thrombus (E + group) were compared with 21 AF patients without complications (E- group).. The E+ group patients demonstrated greater impairment of LAA velocity and higher plasma BNP levels than the E- group patients (LAA velocity: 12+/-6 versus 31+/-17 cm/s, P<0.05; plasma BNP: 126+/-53 versus 86+/-45 ng/L, P<0.05). Overall analysis of the continuous variables with multiple logistic regression analysis revealed that BNP was a significant predictor of thromboembolism. There was a weak but significant negative correlation between plasma BNP levels and LAA flow velocity (r=0.38, P<0.05). No intergroup difference in plasma atrial natriuretic polypeptide levels was found.. The present data suggest the usefulness of measuring plasma BNP levels, which may reflect augmented atrial secretion of BNP from the impaired atrial myocardium, in detecting patients at high risk for thromboembolic complications in nonvalvular AF.

Topics: Adult; Aged; Aged, 80 and over; Atrial Appendage; Atrial Fibrillation; Atrial Function, Left; Atrial Natriuretic Factor; Biomarkers; Blood Flow Velocity; Chronic Disease; Echocardiography, Transesophageal; Electrocardiography; Female; Humans; Logistic Models; Male; Middle Aged; Myocardium; Natriuretic Peptide, Brain; Predictive Value of Tests; Risk Assessment; Thromboembolism

Congestive heart failure (CHF) is characterized by neurohormonal activation, including increased plasma concentrations of atrial natriuretic peptide (ANP) and N-terminal ANP (N-ANP). Onset of atrial fibrillation (AF) further increases these peptides, but it may be hypothesized that concentrations decrease during longstanding AF due to inherent atrial degeneration.. We sought to investigate the relation between neurohormonal activation in patients with CHF and the duration of concomitant AF.. The study group comprised 60 patients (age 70 +/- 8 years) with advanced CHF due to left ventricular systolic dysfunction (left ventricular ejection fraction (LVEF) < 0.35) and chronic AF (duration 21 (1-340) months). Plasma neurohormone concentrations were measured, and multiple regression analysis was performed to identify their clinical predictors.. Median plasma neurohormone concentrations were: ANP 113 pmol/l, N-ANP 1187 pmol/l, norepinephrine 496 pg/ml, renin 127 micro units/l, aldosterone 128 pg/ml and endothelin 8.1 pg/ml. Norepinephrine, renin, aldosterone and endothelin were not significantly related to the duration of AF. In contrast, ANP decreased along with the duration of AF (P = 0.03), while the same trend was observed for N-ANP (P = 0.10). However, for these peptides a first order interaction with LVEF was present, which was not observed in the other neurohormones. In patients with LVEF > 0.25 ANP and N-ANP increased along with the duration of AF, whereas in patients with LVEF < or = 0.25 an inverse relation between ANP (P = 0.02) and N-ANP (P = 0.04) and the duration of AF was present, longer-standing AF being associated with lower concentrations.. In patients with advanced CHF with low LVEF plasma ANP and N-ANP concentrations decrease during longstanding AF. This finding agrees with the concept that longstanding AF leads to impaired ability of the atria to produce these neurohormones due to inherent degenerative changes.

Topics: Aged; Aldosterone; Analysis of Variance; Atrial Fibrillation; Atrial Natriuretic Factor; Female; Heart Failure; Humans; Male; Norepinephrine; Protein Precursors; Renin; Stroke Volume; Time Factors; Ventricular Dysfunction, Left

The study tested the hypothesis that left atrial appendage (LAA) dysfunction in nonvalvular atrial fibrillation (NVAF) correlates with a prothrombotic state, and investigated whether the plasma natriuretic peptides are marker of LAA dysfunction in NVAF. Sixty-seven patients underwent transthoracic and transesophageal echocardiography. The left ventricular fractional shortening, left atrial diameter (LAD), LAA flow velocity and the grade of spontaneous echo contrast (SEC) were determined. The plasma concentrations of atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), D-dimer, and thrombin-antithrombin III complex (TAT) were measured. The patients were divided into 2 groups according to LAA flow velocity: group I (LAA velocity <20 cm/s) and group II (LAA velocity > or = 20cm/s). The SEC score, D-dimer, TAT, BNP and LAD were significantly increased in group I. Based on simple linear regression analysis, SEC score (r=-0.638), LAD (r=-0.493), D-dimer (r = -0.485), BNP (r = -0.463), TAT (r = -0.455) and age (r = -0.314) were inversely correlated with LAA flow velocity. Multivariate analysis showed that SEC score (p = 0.0014) and plasma BNP level (p=0.0075) were independent negative predictors for LAA flow velocity. In conclusion, LAA dysfunction is associated with a prothrombotic state, and the plasma BNP concentration may serve as a determinant of LAA function in NVAF.

Topics: Aged; Atrial Appendage; Atrial Fibrillation; Atrial Function, Left; Atrial Natriuretic Factor; Biomarkers; Blood Flow Velocity; Chronic Disease; Echocardiography, Transesophageal; Humans; Middle Aged; Natriuretic Peptide, Brain; Thrombophilia

Although transient atrial dysfunction has been reported after electrical cardioversion of atrial fibrillation (AF), the difference in the time to recover from the atrial hormonal, mechanical, and electrical dysfunction has not been described. Thus, we evaluated the time course of recovery from atrial hormonal, mechanical, and electrical dysfunction after cardioversion in patients with nonvalvular AF. We attempted electrical cardioversion in 87 consecutive patients with nonvalvular AF that had persisted for > or =6 months, and in 24 patients (28%) with maintained sinus rhythm for > or =6 months. To evaluate atrial hormonal, mechanical, and electrical dysfunction in these 24 patients, we measured plasma concentration of atrial natriuretic peptide, the atrial peak velocity in transmitral flow, and the ratio of peak systolic-to-diastolic pulmonary venous flow (S/D ratio) using echocardiography, and the duration and the root mean voltage for the terminal 20 ms (LP20) of the filtered P wave using P-wave signal-averaged electrocardiography. Atrial natriuretic peptide rapidly returned to baseline within 1 day after cardioversion, and maintained these levels for 6 months. Atrial peak velocity in transmitral flow and S/D ratio were significantly increased at 2 weeks, and continued to increase until 1 month, and then reached a plateau. The duration and LP20 began to recover only 6 months after cardioversion. One to 3 years after conversion, the duration and LP20 had nearly reached a plateau, but the latter value remained below normal. In patients with nonvalvular AF of prolonged duration, recovery from atrial electrical dysfunction after sinus conversion took much longer than that from either atrial hormonal or mechanical dysfunction.

Topics: Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Blood Flow Velocity; Chronic Disease; Electric Countershock; Electrocardiography; Female; Follow-Up Studies; Heart Atria; Humans; Male; Middle Aged; Mitral Valve; Time Factors

The aim of this study was to determine the value of an increase in plasma atrial natriuretic peptide (ANP) concentrations during submaximal exercise as a predictor of return of sinus rhythm (SR), and of its maintenance over a period of 6 months after cardioversion (CV) of chronic atrial fibrillation (AF). The study group included 42 patients with AF (mean duration 7 +/- 7 months) and a controlled ventricular rate. They underwent submaximal exercise testing 24 hours before CV. Blood samples were collected at rest and at peak of exercise for measurement of plasma ANP concentrations. Thirty-five of 42 patients were successfully cardioverted to SR. At 6 months, 23 patients remained in SR, while 12 had recurrence of AF. The plasma ANP concentrations before CV increased insignificantly during exercise in patients with unsuccessful CV or with recurrence of AF (60.8 +/- 17.3 pg/mL to 64 +/- 13.5 pg/mL, NS). The mean increase in plasma ANP concentration during exercise was significantly greater in the 23 patients who remained in SR than in the 19 patients unsuccessfully cardioverted or with recurrence of AF (17.5 +/- 7.6 pg/mL vs 5.8 +/- 4.5 pg/mL, P < 0.01). In multivariate logistic regression analysis, an increase in ANP plasma concentration was independently associated with successful CV and maintenance of SR up to 6 months of observation. In patients with chronic AF an exercise-induced increase in ANP concentration predicts successful CV and maintenance of SR.

Topics: Adult; Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Blood Pressure; Chronic Disease; Electric Countershock; Electrocardiography; Exercise Test; Female; Heart Rate; Humans; Logistic Models; Male; Middle Aged; Oxygen Consumption; Predictive Value of Tests; Recurrence

Atrial filling pressures are increased in acute atrial fibrillation, which stimulates the release of atrial natriuretic factor pro-hormone, proANF.. 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.. 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.. 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.

Topics: Acute Disease; Atrial Fibrillation; Atrial Function; Atrial Natriuretic Factor; Biomarkers; Digoxin; Heart Rate; Humans; Natriuresis; Protein Precursors

The mechanism of postthoracotomy atrial fibrillation (AF) could be related to right ventricular (RV) strain. The effect of oxygen on the occurrence of postoperative AF and on RV function was studied.. A prospective, randomized study.. A university hospital.. Twenty-four noncardiac thoracotomy patients.. At the end of the postoperative anesthesia care unit period, the patients were randomly allocated to receive 35% oxygen until either the third (P = prolonged group) or the first postoperative morning (S = short group).. Measurement of hemodynamic variables using a thermodilution pulmonary artery catheter, oxygenation, concentration of plasma atrial natriuretic peptide (ANP) and Holter monitoring were started preoperatively and continued for the 3 postoperative days (PODs). Systolic RV pressure (systolic RVP) and pulmonary vascular resistance (PVR) increased postoperatively only in group S. Major changes in RV performance were not seen with echocardiography or the thermodilution method in any patient. Silent episodes of AF occurred in three patients (25%) in group P and in one patient (8%) in group S (not significant [NS]) without deviations in plasma ANP concentration. On each of the 3 PODs, all patients were exposed to 60% oxygen for 15 minutes. Systolic RVP decreased significantly during the exposure to 60% oxygen only in group S, but not in patients developing AF. Predictive factors for AF were a high preoperative PVR, intraoperative bleeding necessitating volume loading, and elevated systolic RVP immediately after thoracotomy.. Short episodes of AF occurred irrespective of the length of oxygen therapy. Occurrence of AF could not be explained by changes in RV function.

Topics: Atrial Fibrillation; Atrial Natriuretic Factor; Blood Loss, Surgical; Blood Volume; Catheterization, Swan-Ganz; Echocardiography; Electrocardiography, Ambulatory; Forecasting; Hemodynamics; Humans; Incidence; Lung; Middle Aged; Oxygen; Oxygen Consumption; Oxygen Inhalation Therapy; Plasma Substitutes; Prospective Studies; Pulmonary Artery; Thermodilution; Thoracotomy; Vascular Resistance; Ventricular Dysfunction, Right; Ventricular Function, Right; Ventricular Pressure

It is generally accepted that plasma atrial natriuretic peptide release occurs secondary to atrial stretch. The influence of coordinated atrial contraction (AC) upon this process is not fully appreciated. The aim of the study was to determine the importance of coordinated AC upon peripheral atrial natriuretic peptide levels (alpha-hANP) during exercise. Peripheral alpha-hANP levels were measured at rest and during exercise in 12 patients with complete heart block (CHB) and permanent rate responsive pacemakers. Seven patients had coordinated AC and five had chronic atrial fibrillation (AF). Each patient performed three treadmill exercise tests. Maximal inspired oxygen volume (VO2 max) was determined during test 1. Tests 2 and 3 were performed to 70% VO2 max, the pacemaker being programmed to either VVI or VVIR mode. Plasma alpha-hANP was measured using a two-site immunoradiometric assay. At rest there was a small but significant difference between the two patient groups: AF 60.2 pg/mL versus AC97.6 pg/mL; P = 0.03. During exercise in the AC patients, there was a significant increase in alpha-hANP levels, in VVIR mode, to 238.4 pg/mL, and in VVI mode, to 207.9 pg/mL, P = 0.002 and 0.003, respectively. In those patients with chronic AF, there was no significant rise or fall in alpha-hANP levels in either pacing mode, VVIR 65.2 pg/mL, VVI 46.6 pg/mL. Previous workers have suggested that alpha-hANP release by nonfunctioning atria is normal. We have shown that the presence of coordinated AC is required for the release of alpha-hANP during exercise in patients with CHB, and that this appears to be independent of ventricular rate.

Topics: Adult; Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Cardiac Pacing, Artificial; Chronic Disease; Cross-Over Studies; Echocardiography; Electrocardiography; Exercise Test; Female; Heart Atria; Heart Block; Heart Rate; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Contraction; Oxygen Consumption; Physical Exertion; Rest; Single-Blind Method

Topics: Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Humans; Natriuretic Peptide, Brain; Peptide Fragments

Topics: Atrial Fibrillation; Atrial Natriuretic Factor; Humans; Linear Models; Multivariate Analysis; Natriuretic Peptide, Brain

Topics: Atrial Appendage; Atrial Fibrillation; Atrial Natriuretic Factor; Humans; Natriuretic Peptide, Brain

Atrial natriuretic peptide (ANP) deficiency is thought to be one of the causes of heart failure induced by atrial fibrillation (AF). Although ANP deficiency is thought to occur as a result of atrial remodeling, data to explain this mechanism are limited. The purpose of this study was to investigate the association between ANP and left atrial remodeling or prognosis of heart failure in patients with AF ablation.. In total, 373 consecutive patients who underwent initial ablation for persistent AF [age, 67 ± 10 years; female, 97 (26%)] were retrospectively enrolled. ANP and brain natriuretic peptide (BNP) were measured before the procedure and the ANP/BNP ratio was calculated. Left atrial volume index, left atrial appendage emptying velocity, and left atrial low-voltage areas (LVAs) were used as left atrial-remodeling parameters. The primary outcome of heart failure was defined as the composite of all-cause death or hospitalization due to worsening heart failure.. The median ANP level was 116 (71-178) pg/ml and the median ANP/BNP ratio was 0.65 (0.46-1.00). The ANP/BNP ratio decreased with increasing left atrial volume index or LVAs and with decreasing left atrial appendage emptying velocity. During the 5-year follow-up, freedom from the primary outcome was significantly lower in patients with ANP/BNP ratio ≤0.65 than in those with ANP/BNP ratio >0.65 (84.6% versus 95.6%, P  < 0.01).. Secretion of ANP relative to BNP decreased with progression of left atrial remodeling in patients with AF ablation. Furthermore, prognosis of heart failure was poor in patients with a low ANP/BNP ratio.

Topics: Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Atrial Remodeling; Female; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Retrospective Studies

Topics: Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Humans; Natriuretic Peptide, Brain; Natriuretic Peptides

Topics: Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Catheter Ablation; Humans; Natriuretic Peptide, Brain

Two siblings presented with cardiomyopathy, hypertension, arrhythmia, and fibrosis of the left atrium. Each had a homozygous null variant in

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Natriuretic Factor; Cardiomyopathies; Fibrosis; Heart Atria; Humans; Hypertension; Natriuretic Peptide, Brain; Serine Endopeptidases; Siblings

With aging, the human atrium invariably develops amyloid composed of ANP (atrial natriuretic peptide) and BNP (B-type natriuretic peptide). Preamyloid oligomers are the primary cytotoxic species in amyloidosis, and they accumulate in the atrium during human hypertension and a murine hypertensive model of atrial fibrillation susceptibility. We tested the hypothesis that preamyloid oligomers derived from natriuretic peptides cause cytotoxic and electrophysiological effects in atrial cells that promote arrhythmia susceptibility and that oligomer formation is enhanced for a mutant form of ANP linked to familial atrial fibrillation.. Oligomerization was assessed by Western blot analysis. Bioenergic profiling was performed using the Seahorse platform. Mitochondrial dynamics were investigated with immunostaining and gene expression quantitated using quantitative reverse transcription polymerase chain reaction. Action potentials and ionic currents were recorded using patch-clamp methods and intracellular calcium measured using Fura-2.. Oligomer formation was markedly accelerated for mutant ANP (mutANP) compared with WT (wild type) ANP. Oligomers derived from ANP, BNP, and mutANP suppressed mitochondrial function in atrial HL-1 cardiomyocytes, associated with increased superoxide generation and reduced biogenesis, while monomers had no effects. In hypertensive mice, atrial cardiomyocytes displayed reduced action potential duration and maximal dV/dT of phase 0, with an elevated resting membrane potential, compared with normotensive mice. Similar changes were observed when atrial cells were exposed to oligomers. mutANP monomers produced similar electrophysiological effects as mutANP oligomers, likely due to accelerated oligomer formation, while ANP and BNP monomers did not. Oligomers decreased Na. These findings provide compelling evidence that natriuretic peptide oligomers are novel mediators of atrial arrhythmia susceptibility. Moreover, the accelerated oligomerization by mutANP supports a role for these mediators in the pathophysiology of this mutation in atrial fibrillation.

Topics: Animals; Atrial Fibrillation; Atrial Natriuretic Factor; Heart Atria; Mice; Myocytes, Cardiac; Natriuretic Peptide, Brain

Midregional pro-atrial natriuretic peptide (MR-proANP) is a promising biomarker to differentiate the underlying etiology of acute ischemic stroke (AIS).. This study aimed to determine the role of MR-proANP for classification as cardioembolic (CE) stroke, identification of newly diagnosed atrial fibrillation (NDAF), and risk assessment for major adverse cardiovascular events (MACE).. This study measured MR-proANP prospectively collected within 24 hours after symptom-onset in patients with AIS from the multicenter BIOSIGNAL (Biomarker Signature of Stroke Aetiology) cohort study. Primary outcomes were CE stroke etiology and NDAF after prolonged cardiac monitoring, as well as a composite outcome of MACE (recurrent cerebrovascular events, myocardial infarction, or cardiovascular death) within 1 year. Logistic/Poisson and subproportional hazard regression were applied to evaluate the association between MR-proANP levels and outcomes. Additionally, a model for prediction of NDAF was derived and validated as a decision tool for immediate clinical application.. Between October 1, 2014, and October 31, 2017, this study recruited 1,759 patients. Log. MR-proANP is a valid biomarker to determine risk of NDAF and MACE in patients with AIS and can be used as a decision tool to identify patients for prolonged cardiac monitoring. (Biomarker Signature of Stroke Aetiology Study: The BIOSIGNAL study [BIOSIGNAL]; NCT02274727).

Topics: Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Cohort Studies; Humans; Ischemic Stroke; Risk Assessment

Topics: Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Humans; Natriuretic Peptide, Brain; Peptide Fragments

Human induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs) can model heritable arrhythmias to personalize therapies for individual patients. Although atrial fibrillation (AF) is a leading cause of cardiovascular morbidity and mortality, current platforms to generate iPSC-atrial (a) CMs are inadequate for modeling AF. We applied a combinatorial engineering approach, which integrated multiple physiological cues, including metabolic conditioning and electrical stimulation, to generate mature iPSC-aCMs. Using the patient's own atrial tissue as a gold standard benchmark, we assessed the electrophysiological, structural, metabolic, and molecular maturation of iPSC-aCMs. Unbiased transcriptomic analysis and inference from gene regulatory networks identified key gene expression pathways and transcription factors mediating atrial development and maturation. Only mature iPSC-aCMs generated from patients with heritable AF carrying the non-ion channel gene (NPPA) mutation showed enhanced expression and function of a cardiac potassium channel and revealed mitochondrial electron transport chain dysfunction. Collectively, we propose that ion channel remodeling in conjunction with metabolic defects created an electrophysiological substrate for AF. Overall, our electro-metabolic approach generated mature human iPSC-aCMs that unmasked the underlying mechanism of the first non-ion channel gene, NPPA, that causes AF. Our maturation approach will allow for the investigation of the molecular underpinnings of heritable AF and the development of personalized therapies.

Topics: Atrial Fibrillation; Atrial Natriuretic Factor; Humans; Induced Pluripotent Stem Cells; Ion Channels; Myocytes, Cardiac

Atrial fibrillation (AF) is common following ST-segment elevation myocardial infarction (STEMI). Increased blood levels of mid regional pro atrial natriuretic peptide (MR-proANP) have been associated with a greater risk of incident AF. However, knowledge of the value of MR-proANP in predicting incident AF after STEMI is sparse. To assess whether MR-proANP measured at admission is associated with development of incident AF in patients with STEMI. 673 STEMI patients with no history of AF treated with primary percutaneous coronary intervention (pPCI) were prospectively enrolled from September 2006 to December 2008. Blood samples were drawn before the procedure. MR-proANP was measured by an automated processing assay. End point was incident AF. Median follow-up time was 5.5 years (interquartile-range 4.7-6.0), during which 63 patients developed AF. In a multivariable Cox regression model adjusted for relevant clinical and biochemical variables, MR-proANP was significantly associated with the development of AF (HR 1.18 per 100 pmol, 95% CI 1.11-1.28, p < 0.001). In a subgroup of patients who underwent echocardiography (N = 360), MR-proANP remained significantly associated with the development of AF (HR 1.39 per 100 pmol, 95% CI 1.13-1.71, p = 0.002) after adjusting for clinical and biochemical variables and left ventricular ejection fraction. When stratifying patients according to tertiles of MR-proANP, patients in the upper tertile displayed an 11 times greater risk of developing AF during follow-up as compared to patients in the lower tertile (HR 11.1, 95% CI 4.4-28.2, p < 0.001). Plasma MR-proANP measured at admission is an independent predictor of incident AF after STEMI.

Topics: Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Humans; ST Elevation Myocardial Infarction; Stroke Volume; Ventricular Function, Left

BACKGROUND The left atrial appendage (LAA) is an organ with neuroendocrine function. It remains unclear whether left atrial appendage closure (LAAC) has physiological effects on neuroendocrine function in patients with nonvalvular atrial fibrillation (NVAF). In the present study, we aimed to investigate the effects of LAAC on neuroendocrine function in patients with NVAF. MATERIAL AND METHODS We enrolled 20 patients with NVAF treated by LAAC in Jiangsu Taizhou People's Hospital from October 2019 to October 2020. Blood samples were collected 1 day before LAAC and 12 months after LAAC. Plasma concentrations of adrenaline, aldosterone, pro-atrial natriuretic peptide (NT-proANP), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were measured. RESULTS LAAC was successfully performed in all patients, without serious complications. Compared with the preoperative levels, there was no significant difference in the levels of NT-proANP, NT-proBNP, and epinephrine at 12 months after LAAC (P>0.05). However, there was a significant decrease in aldosterone level at 12 months post-procedure (209.04±132.98 pg/ml) compared with pre-procedure baseline (279.08±166.88 pg/ml, P=0.04). There was no correlation between the compression rate of the occlusion and the reduction of aldosterone (Kendall's Tau-b=0.159, P=0.351). CONCLUSIONS LAAC can be safely and effectively performed in NVAF patients, and showed no significant effect on the adrenergic system and natriuretic peptides, but had an influence on the RAAS.

Topics: Adrenergic Agents; Aldosterone; Atrial Appendage; Atrial Fibrillation; Atrial Natriuretic Factor; Epinephrine; Humans; Natriuretic Peptide, Brain; Treatment Outcome

Left atrial appendage (LAA) isolation is an effective surgical treatment for decreasing thromboembolic risk. We sought to evaluate the short-term effect of minimally invasive surgery with LAA excision on left atrial dynamic and endocrine function in atrial fibrillation (AF) patients.. A total of 52 patients with paroxysmal AF undergoing minimally invasive surgery with LAA excision in Anzhen Hospital from October 2012 to June 2014 were enrolled in the study. The natriuretic peptide plasma level was determined by enzyme-linked immunosorbent assay (ELISA), and left atrial dynamic function was measured preprocedure by real-time three-dimensional echocardiography and postprocedure after 7 days and 3 months.. With the exception of six recurrences, 88.5% (46/52) of the patients were prospectively followed over 3 months in terms of their sinus rhythm postprocedure. No severe operative complications or embolism events occurred within those 3 months. Echocardiography showed a 3-6% decrease in left atrial volume postprocedure, and dynamic function was largely restored by 3 months. There was no significant change in natriuretic peptide levels, although a slight decrease was detected 7 days postprocedure, which gradually recovered by 3 months (P = 0.350).. There are no significant differences in left atrial dynamics and natriuretic peptide secretion in AF patients after minimally invasive surgery with LAA excision.

Topics: Action Potentials; Adult; Aged; Atrial Appendage; Atrial Fibrillation; Atrial Function, Left; Atrial Natriuretic Factor; Biomarkers; Echocardiography, Three-Dimensional; Enzyme-Linked Immunosorbent Assay; Female; Heart Rate; Humans; Male; Middle Aged; Pilot Projects; Prospective Studies; Recurrence; Thoracoscopy; Time Factors; Treatment Outcome

The T2238C variant of the atrial natriuretic peptide (ANP) gene has emerged as a novel risk factor for the incidence of cardiovascular events. However, the impact of this variant on cardiovascular outcome in patients with atrial fibrillation (AF) is unknown.. We included 557 anticoagulated patients with non-valvular AF randomly selected from the prospective ATHERO-AF cohort. Patients underwent genetic analysis for the T2238C/ANP variant and were grouped as wild type or heterozygous or homozygous for C2238 variant allele. Primary endpoint was a composite of cardiovascular events (CVEs) including cardiovascular death, fatal/non-fatal ischemic stroke and myocardial infarction. Overall, 429 patients carried the TT wild type genotype, 110 patients (19.7%) were heterozygous (T/C) and 18 patients (3.2%) were homozygous (CC).. Incidence of CVEs was higher in homozygous patients for C2238 allele at unadjusted analysis (log-rank test, p = 0.042 for additive model, p = 0.043 for recessive model). The multivariable Cox proportional hazards regression analysis confirmed that C2238 ANP allele was associated with CVEs in the additive (p = 0.008) and recessive models (p = 0.005).. Carrier status for the C2238/ANP variant allele is associated with an increased risk of CVEs in anticoagulated AF patients.

Topics: Atrial Fibrillation; Atrial Natriuretic Factor; Cohort Studies; Humans; Myocardial Infarction; Prospective Studies

Postoperative atrial fibrillation (POAF) represents a common complication after cardiac surgery associated with major adverse events and poor patient outcome. Tools for risk stratification of this arrhythmia remain scarce. Atrial natriuretic peptide (ANP) represents an easily assessable biomarker picturing atrial function and strain; however, its prognostic potential on the development of POAF has not been investigated so far.. Within the present investigation, 314 patients undergoing elective cardiac surgery were prospectively enrolled. Preoperative mid-region proANP (MR-proANP) values were assessed before the surgical intervention. Patients were followed prospectively and continuously screened for the development of arrhythmic events.. MR-proANP proved to be a strong and independent predictor of the development of POAF. Considering a personalized diagnostic and prognostic preoperative work-up, a standardized preoperative evaluation of MR-proANP levels might help to identify patients at risk for development of POAF after cardiac surgery.

Topics: Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Cardiac Surgical Procedures; Female; Humans; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome

A 74-year-old woman with a history of diastolic heart failure and refractory atrial fibrillation (AF) presented with unstable angina for coronary artery bypass grafting. Routine pathological analysis of tissue specimens obtained from the left atrial appendage revealed subendocardial and interstitial fibrosis and patchy amyloid deposits with Congo red staining demonstrating filamentous deposits. Mass spectrometry was consistent with isolated atrial amyloidosis (IAA). IAA in this patient was found incidentally on routine postoperative pathology, but likely contributed to significant morbidity. The established relationship between IAA with AF and diastolic heart failure underscores the relevance. Further delineating the pathogenesis has potentially immense implications for the future management of associated conditions. To bridge the gaps in the understanding, a standardised approach to diagnosis is needed to open the door to a large-scale study and further work toward establishing evidence-based management pathways.

Topics: Aged; Amyloid; Amyloidosis; Atrial Fibrillation; Atrial Natriuretic Factor; Female; Heart Atria; Humans

In patients with atrial fibrillation (AF), left atrial (LA) enlargement, and the presence of low-voltage areas (LVAs) indicate an advanced disease stage. NT-proANP is a biomarker, which is significantly higher in both phenotypes. Prediction of LVAs before catheter ablation could impact the prognosis and therapeutical management in AF patients.. The aim of this study was to (a) analyze the predictive value of a novel biomarker-based AF substrate prediction score, and (b) compare it with DR-FLASH and APPLE scores.. Patients undergoing first AF catheter ablation were included. LA volume (LAV) was analyzed prior to ablation using cardiovascular magnetic resonance imaging (CMR). Blood plasma samples from the femoral vein were collected before AF ablation. NT-proANP was analyzed using commercially available assays. LVAs were determined using high-density maps during catheter ablation and defined as <0.5 mV. The novel ANP score (one point for Age ≥ 65 years, NT-proANP > 17 ng/mL, and Persistent AF) was calculated at baseline.. The study population included 156 AF patients (64 ± 10 years, 65% males, 61% persistent AF, 28% LVAs). The cut-off ANP score ≥ 2 demonstrated 77% sensitivity and 70% specificity. On logistic regression (odds ratio [OR] 3.469) and receiver operating characteristic (ROC) analysis (area under the curve [AUC] 0.778, P < .001), the ANP score significantly predicted LVAs presence. There were no differences between novel ANP score - which is a new one - is described in the Abstract; with APPLE (AUC 0.718, P = .378) and DR-FLASH (AUC 0.766, P = .856) scores.. The novel biomarker-based ANP score demonstrates good prediction of LVAs.

Topics: Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Catheter Ablation; Electrophysiologic Techniques, Cardiac; Female; Heart Atria; Humans; Male; Middle Aged; Protein Precursors; Risk Factors

Natriuretic peptides are extensively studied biomarkers for atrial fibrillation (AF) and heart failure (HF). Their role in the pathogenesis of both diseases is not entirely understood and previous studies several single-nucleotide polymorphisms (SNPs) at the NPPA-NPPB locus associated with natriuretic peptides have been identified. We investigated the causal relationship between natriuretic peptides and AF as well as HF using a Mendelian randomization approach.. N-terminal pro B-type natriuretic peptide (NT-proBNP) (N = 6669), B-type natriuretic peptide (BNP) (N = 6674), and mid-regional pro atrial natriuretic peptide (MR-proANP) (N = 6813) were measured in the FINRISK 1997 cohort. N = 30 common SNPs related to NT-proBNP, BNP, and MR-proANP were selected from studies. We performed six Mendelian randomizations for all three natriuretic peptide biomarkers and for both outcomes, AF and HF, separately. Polygenic risk scores (PRSs) based on multiple SNPs were used as genetic instrumental variable in Mendelian randomizations. Polygenic risk scores were significantly associated with the three natriuretic peptides. Polygenic risk scores were not significantly associated with incident AF nor HF. Most cardiovascular risk factors showed significant confounding percentages, but no association with PRS. A causal relation except for small causal betas is unlikely.. In our Mendelian randomization approach, we confirmed an association between common genetic variation at the NPPA-NPPB locus and natriuretic peptides. A strong causal relationship between natriuretic peptides and incidence of AF as well as HF at the community-level was ruled out. Therapeutic approaches targeting natriuretic peptides will therefore very likely work through indirect mechanisms.

Topics: Adult; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Cohort Studies; Female; Heart Failure; Humans; Male; Mendelian Randomization Analysis; Middle Aged; Natriuretic Peptide, Brain; Natriuretic Peptides; Peptide Fragments

MR-pro ANP is a novel peptide with multiple biological functions, especially within the cardiovascular system. It plays an important role in physiological and pathological processes in the human body and its level may be clinically relevant in new onset atrial fibrillation. The aim of this study was to determine whether elevated MR-proANP level is a predictor of new-onset atrial fibrillation in patients with acute myocardial infarction.. MR-proANP might be a good predictor of new-onset atrial fibrillation in patients with acute myocardial infarction.

Topics: Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Female; Heart Failure; Humans; Middle Aged; Myocardial Infarction

Assess the diagnostic significance of markers of heart failure, to identify the features of clinical symptoms and structural and functional remodeling of the left and right heart in patients with chronic heart failure (CHF) in combination with atrial fibrillation (AF) and chronic obstructive pulmonary disease (COPD).. groups of patients were formed: group 1 - patients with COPD without cardiovascular diseases (n=28), group 2 - patients with CHF and COPD without AF (n=30), group 3 - patients with CHF and AF without COPD (n=33), group 4 (main) - patients with CHF, AF and COPD (n=29). Patients were evaluated for clinical symptoms, 6-minute walk test, echocardiographic study, determined the concentration of natriuretic peptides (NUP): N-terminal fragment of the precursor of cerebral NUP (NT-proBNP) and mid-regional pro-atrial NUP (MR-proANP).. In patients with CHF on the background of AF and COPD, a higher score of the severity of clinical symptoms was established in comparison with the 3rd group (p<0,001). The features of heart remodeling in patients of the main group were revealed in comparison with patients with CHF and AF without COPD: lower volume indices of the left (p=0,001) and right (p=0,004) atria and values of the indexed index of the end-diastolic area of the right ventricle (RV) (p=0,007), lower contractility of the RV, the presence of RV hypertrophy. The effect of AF on the structural and functional parameters of the heart in patients with CHF, COPD and AF can be judged by comparison with patients with CHF and COPD without AF: higher values of the size of the RV (p=0,012), indexed index of the end-systolic area of the RV (p<0,001), lower systolic function of the RV on the background of higher pressure in the RV cavity (p=0,001). Defined the highest level of NT-proBNP in patients with CHF, AF and COPD in comparison with its level in patients of the 2nd group (p<0,001) and in patients 3rd groups (p=0,010). Higher levels of MR-proANP were found in patients with CHF and AF without COPD (p<0,001).. In patients with CHF, AF and COPD, more pronounced clinical symptoms are caused by chronic bronchial obstruction. Pathogenetic features of left and right heart remodeling in patients with CHF on the background of AF and COPD were revealed. For the early detection of HF in patients with AF the greatest diagnostic importance is the determination of the level of MR-proANP, however, in patients with combined AF and COPD the most informative is the determination of the concentration of NT-proBNP.

Topics: Atrial Fibrillation; Atrial Natriuretic Factor; Heart Atria; Heart Failure; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Pulmonary Disease, Chronic Obstructive

Low voltage areas (LVAs) represent advanced remodelling processes in left atrium in patients with atrial fibrillation (AF) and are associated with higher rates of arrhythmia recurrences. However, the prediction of LVA based on clinical parameters is understudied. Recently, we introduced APPLE score to predict rhythm outcomes after catheter ablation. The aim of this study was to analyse (i) LVA prediction using APPLE score and (ii) differences in biomarker profiles according to APPLE score in AF patients.. Patients undergoing first AF ablation were included. The APPLE score (one point for Age >65 years, Persistent AF, imPaired eGFR <60 mL/min/1.73 m2, LA diameter ≥43 mm, EF <50%) was calculated before ablation. Blood plasma samples from femoral vein were collected before ablation. Low voltage area were determined using high-density maps and defined as <0.5 mV. NT-proANP, NT-proBNP, L-Selectin, and vascular cell adhesion protein 1 (VCAM-1) were studied using commercially available assays. We studied 214 patients [age median (interquartile range) 65 (57-72) years, 59% males, 59% persistent AF, 27% LVA]. There were 42% patients with APPLE ≥3. The levels of NT-proANP (P < 0.001), NT-proBNP (P = 0.016), and VCAM-1 (P = 0.040) increased with each APPLE point. In the univariable analysis, APPLE score [odds ratio (OR) 1.921, 95% confidence interval (CI) 1.453-2.538; P < 0.001], female gender (OR 2.283, 95% CI 1.280-4.071; P = 0.005), and NT-proANP (OR 1.031, 95% CI 1.008-1.054; P = 0.007) were significant predictors for LVA. On the multivariable analysis, only APPLE score and female gender remained associated with LVA.. The APPLE score can be used for prediction of LVA before AF ablation. There was a positive correlation between biomarker levels and APPLE score.

Topics: Action Potentials; Age Factors; Aged; Atrial Fibrillation; Atrial Function, Left; Atrial Natriuretic Factor; Atrial Remodeling; Biomarkers; Catheter Ablation; Decision Support Techniques; Female; Glomerular Filtration Rate; Heart Rate; Humans; Kidney; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Pilot Projects; Predictive Value of Tests; Pulmonary Veins; Recurrence; Risk Assessment; Risk Factors; Sex Factors; Time Factors; Treatment Outcome; Vascular Cell Adhesion Molecule-1

We investigated whether the increase of plasma natriuretic peptides (NPs) in atrial fibrillation (AF) is independent of the effect of AF on the left atrial (LA) hemodynamics.. Hemodynamically stable patients scheduled for AF ablation underwent assessment of B-type natriuretic peptide (BNP) and mid-regional pro-atrial natriuretic peptide (MR-proANP), echocardiography, and direct measurement of left atrial (LA) pressure. Concentrations of the NPs were compared between patients in AF (n = 31) and controls in sinus rhythm (SR; n = 31) who were matched for age, gender, heart rate, left ventricular ejection fraction, LA volume index, and directly measured mean LA pressure. Eighteen patients underwent serial measurement of NPs and LA pressure during native SR and after 20 min of pacing-induced AF.. Compared to the patients in SR, the patients in AF had 2.6 times higher unadjusted BNP [median (inter-quartile range), 101 (63, 129) vs. 38 (26, 79) ng/L] and two times higher unadjusted MR-proANP [183 (140, 230) vs. 91 (67, 135) pmol/L; both p < 0.001]. Concentrations of both NPs correlated with mean LA pressure in the patients in SR (r = 0.75 for BNP and 0.62 for MR-proANP, both p < 0.001) but not in the patients in AF (r = 0.18 and 0.04, respectively, both p > 0.3). Both NPs increased significantly during induced AF [adjusted median (IQR) relative change, BNP: 27 (22; 40)%, MR-proANP: 75 (64; 99)%, both p < 0.001] without a significant change in the LA pressure.. The increase of NPs in AF was independent of its effect on the LA hemodynamics.

Topics: Atrial Appendage; Atrial Fibrillation; Atrial Natriuretic Factor; Atrial Pressure; Biomarkers; Catheter Ablation; Disease Progression; Echocardiography; Female; Follow-Up Studies; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Prognosis; Prospective Studies; Ventricular Function, Left

See Article by Whitman et al.

Topics: Atrial Fibrillation; Atrial Natriuretic Factor; Heart Failure; Humans; Natriuretic Peptides

Information on alcohol consumption in patients undergoing radiofrequency ablation (RFA) of atrial fibrillation (AF) is often limited by the reliance on self-reports. The aim of this study was to describe the long-term alcohol consumption, measured as ethyl glucuronide in hair (hEtG), in patients undergoing RFA due to AF, and to examine potential associations with cardiac biomarkers, left atrial size and re-ablation within one year after the initial RFA.. The amount of hEtG was measured in patients referred for RFA, and a cut-off of 7 pg/mg was used. N-terminal pro B-type natriuretic peptide (NT-proBNP) and the mid-regional fragment of pro atrial natriuretic peptide (MR-proANP) were examined and maximum left atrium volume index (LAVI) was measured. The number of re-ablations was examined up to one year after the initial RFA. Analyses were stratified by gender, and adjusted for age, systolic blood pressure, body mass index, presence of heart failure and heart rhythm for analyses regarding NT-proBNP, MR-proANP and LAVI and heart rhythm being replaced by type of AF for analyses regarding re-ablation.. In total, 192 patients were included in the study. Median (25th- 75th percentile) NT-proBNP in men with hEtG ≥ 7 vs. < 7 pg/mg was 250 (96-695) vs. 130 (49-346) pg/ml (p = 0.010), and in women it was 230 (125-480) vs. 230 (125-910) pg/ml (p = 0.810). Median MR-proANP in men with hEtG ≥ 7 vs. < 7 pg/mg was 142 (100-224) vs. 117 (83-179) pmol/l (p = 0.120) and in women it was 139 (112-206) vs. 153 (93-249) pmol/l (p = 0.965). The median of maximum LAVI was 30.1 (26.7-33.9) vs. 25.8 (21.4-32.0) ml/m2 (p = 0.017) in men, and 25.0 (18.9-29.6) vs. 25.7 (21.7-34.6) ml/m2 (p = 0.438) in women, with hEtG ≥ 7 vs. < 7 pg/ml, respectively. Adjusted analyses showed similar results, except for MR-proANP turning out significant in men with hEtG ≥ 7 vs. < 7 pg/mg (p = 0.047). The odds ratio of having a re-ablation was 3.5 (95% CI 1.3-9.6, p = 0.017) in men with hEtG ≥ 7 vs. < 7 pg/mg, while there was no significant difference in women.. In male patients with AF and hEtG ≥ 7 pg/mg, NT-proBNP and MR-proANP were higher, LA volumes larger, and there was a higher rate of re-ablations, as compared to men with hEtG < 7 pg/mg. This implies that men with an alcohol consumption corresponding to an hEtG-value ≥ 7, have a higher risk for LA remodelling that could potentially lead to a deterioration of the AF situation.

Topics: Aged; Alcohol Drinking; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Catheter Ablation; Echocardiography; Female; Glucuronates; Hair; Heart Atria; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments

Atrial fibrillation (AF) affects >30 million individuals worldwide. However, no genetic mutation from human patients with AF has been linked to inflammation. Here, we show that AF-associated human variant p.Ile138Thr in natriuretic peptide A (

Topics: Animals; Atrial Fibrillation; Atrial Natriuretic Factor; Cells, Cultured; Cyclic GMP; Female; Fibrosis; HEK293 Cells; Humans; Immunity, Innate; Interleukin-1beta; Male; Mutation, Missense; Myofibroblasts; NF-kappa B; Rats; Rats, Sprague-Dawley; Signal Transduction; Tumor Necrosis Factor-alpha

Closure of the left atrial appendage (LAA) to prevent cardioembolic events is an alternative therapy to oral anticoagulation in patients with non-valvular atrial fibrillation. The LAA is an important source of natriuretic peptides and its exclusion from the circulation may alter the blood level of these hormones, thereby influencing their diagnostic value and clinical effects.. We aimed to prospectively assess potential changes in mid-regional pro A-type natriuretic peptide (MR-proANP) and N-terminal pro B-type natriuretic peptide (NT-proBNP) levels 6 weeks and 6 months after interventional LAA closure using the WATCHMAN device.. In 29 consecutive patients with successful LAA closure baseline MR-proANP level was 274±208pmol/l and decreased by -24.5±68 (p=0.07) and -15.0±44pmol/l (p=0.10) after 6 weeks and 6 months, respectively. The drop in the MR-proANP level after 6 weeks and 6 months was significant in patients with elevated (≥214pmol/l) baseline MR-proANP level (n=15: -54.3±78.0, p<0.01 and -31.8±45.4pmol/l, p=0.03, respectively) and those with reduced left ventricular ejection fraction (LVEF<45%, n=7: -87.4±97.3, p=0.02 and -60.3±42.6pmol/l, p=0.01, respectively). Baseline NT-proBNP level (median 1054pg/ml; IQR 621-1977pg/ml), sodium, potassium, mean systolic or diastolic blood pressure did not change significantly in the mentioned patient groups.. After LAA closure, MR-proANP level decreased significantly in patients with elevated baseline MR-proANP level or reduced LVEF, whereas NT-proBNP level remained unchanged, thereby altering the correlation coefficient between the two biomarkers. Our findings should be considered when using these biomarkers for diagnostic or prognostic evaluation in patients with interventional LAA closure.

Topics: Aged; Atrial Appendage; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Cardiac Surgical Procedures; Echocardiography, Transesophageal; Electrocardiography; Female; Follow-Up Studies; Humans; Male; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Prospective Studies; Protein Precursors; Septal Occluder Device; Stroke

Topics: Atrial Appendage; Atrial Fibrillation; Atrial Natriuretic Factor; Homeostasis; Humans

Postoperative AF (POAF) is the most common cause of morbidity after coronary artery bypass surgery. In this study, we aimed to show the relationship between POAF and N-terminal pro-atrial natriuretic peptide (NT-pro ANP) levels and the relationship between mechanical functions and left atrial volume measured using preoperative three-dimensional echocardiography (3D ECHO) among patients that will undergo isolated coronary artery bypass grafting (CABG) in elective conditions.. Sixty-six consecutive patients (51 male, 15 female) who were decided to undergo CABG and had normal sinus rhythm were involved in the study. Patients were followed by continuous electrocardiography monitoring and daily electrocardiogram. LA volume and mechanical functions were calculated with 3D ECHO. In addition, for the analysis of plasma levels of NT-pro ANP, blood samples were collected before the surgery.. During follow-up after the operation, 15 patients (22.7%) had postoperative atrial fibrillation. LA Vmax, Vmin, VpreA values were higher (P < .001, P = .004, P < .001 respectively) Also in POAF-developed group and SR group, LAVI values were 27.56 ± 4.2 and 20.7 ± 4.64 mL/m. It was found that 3D echocardiography can be used as a helping noninvasive method to show subclinical atrial volume and mechanical dysfunction in patients undergoing CABG. Also, blood levels of NT-pro ANP in POAF group were increased.

Topics: Aged; Atrial Fibrillation; Atrial Function, Left; Atrial Natriuretic Factor; Biomarkers; Coronary Artery Bypass; Coronary Artery Disease; Echocardiography, Three-Dimensional; Female; Follow-Up Studies; Heart Atria; Humans; Male; Middle Aged; Postoperative Complications; Predictive Value of Tests; Protein Precursors; Retrospective Studies

Atrial myocyte hypertrophy is one of the most important substrates in the development of atrial fibrillation (AF). The TWEAK/Fn14 axis is a positive regulator of cardiac hypertrophy in cardiomyopathy. This study therefore investigated the effects of Fn14 on atrial hypertrophy and underlying cellular mechanisms using HL-1 atrial myocytes. In patients with AF, Fn14 protein levels were higher in atrial myocytes from atrial appendages, and expression of TWEAK was increased in peripheral blood mononuclear cells, while TWEAK serum levels were decreased. In vitro, Fn14 expression was up-regulated in response to TWEAK treatment in HL-1 atrial myocytes. TWEAK increased the expression of ANP and Troponin T, and Fn14 knockdown counteracted the effect. Inhibition of JAK2, STAT3 by specific siRNA attenuated TWEAK-induced HL-1 atrial myocytes hypertrophy. In conclusion, TWEAK/Fn14 axis mediates HL-1 atrial myocytes hypertrophy partly through activation of the JAK2/STAT3 pathway.

Topics: Aged; Animals; Atrial Fibrillation; Atrial Natriuretic Factor; Cardiomegaly; Case-Control Studies; Cytokine TWEAK; Disease Models, Animal; Female; Gene Expression Regulation; Heart Atria; Humans; Janus Kinase 2; Leukocytes, Mononuclear; Male; Mice; Middle Aged; Myocytes, Cardiac; Primary Cell Culture; RNA, Small Interfering; Signal Transduction; STAT3 Transcription Factor; Troponin T; TWEAK Receptor

Topics: Adrenomedullin; Adult; Aged; Ankle Brachial Index; Anticoagulants; Asymptomatic Diseases; Atrial Fibrillation; Atrial Natriuretic Factor; C-Reactive Protein; Cardiovascular Diseases; Carotid Intima-Media Thickness; Female; Fibrinogen; Germany; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Phenprocoumon; Protein Precursors; Pulmonary Embolism; Risk Factors; Stroke; Stroke Volume; Vascular Stiffness; Venous Thrombosis; Warfarin

Background Enlargement of left atrial ( LA ) size indicates advanced disease stage in patients with atrial fibrillation ( AF ) and is associated with poor success of different AF therapies. Two dimensional echocardiographic LA measurements do not reliably reflect the true size of LA anatomy. The aim of the current study was: 1) to analyze cardiovascular magnetic resonance ( CMR )-derived LA dimensions and their association with low voltage areas ( LVA ); and 2) to investigate the association between these parameters and NT -pro ANP (N-terminal proatrial natriuretic peptide) levels. Methods and Results Patients undergoing first AF catheter ablation were included. All patients underwent CMR imaging (Ingenia 1.5T Philips) before intervention. CMR data ( LA volume, superior-inferior, transversal and anterior-posterior LA diameters) were measured in all patients. LVA were determined using high-density maps and a low voltage threshold <0.5 mV. Blood plasma samples from femoral vein were collected before catheter ablation. NT -pro ANP levels were studied using commercially available assays. There were 216 patients (65±11 years, 59% males, 56% persistent AF , 26% LVA ) included into analyses. NT -pro ANP levels in patients with LVA were significantly higher than in those without (median/interquartile range 22 [13-29] versus 15 [9-22] pg/mL, P=0.004). All CMR derived LA diameters correlated significantly with persistent AF ( r²=0.291-0.468, all P<0.001), LVA ( r²=0.187-0.306, all P<0.001), and NT -pro ANP levels ( r²=0.258-0.352, P<0.01). On logistic regression multivariable analysis, age (odds ratio=1.090, 95% confidence interval: 1.030-1.153, P=0.003), females (odds ratio=2.686, 95% confidence interval: 1.047-6.891, P=0.040), and LA volume (odds ratio=1.022, 95% confidence interval: 1.009-1.035, P=0.001) remained significant predictors for LVA . Conclusions Left atrial CMR parameters are associated with persistent AF , low voltage areas and NT -pro ANP levels. LA volume is the most significant predictor for LVA .

Topics: Adolescent; Adult; Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Echocardiography; Electrophysiologic Techniques, Cardiac; Female; Heart Atria; Humans; Magnetic Resonance Imaging, Cine; Male; Middle Aged; Prognosis; Protein Precursors; Retrospective Studies; Young Adult

Paroxysmal atrial fibrillation (PAF) is often asymptomatic but nonetheless harmful. We evaluated the performance of disease-related blood biomarkers and CHA2DS2-VASc score to discriminate for PAF in patients with continuous rhythm monitoring.. Clinical data and blood samples were obtained from patients with dual-chamber pacemakers selected according to the absence (no_AHRE) or presence of Atrial High-Rate Episodes (AHRE) >6 min in recent device history (case-control approach). We included 93 patients (n = 49 AHRE, n = 44 no_AHRE). In a subgroup with high AHRE burden and confirmed PAF 15 biomarkers were evaluated (n = 19 AHRE-AF vs. n = 20 no_AHRE). Significantly regulated biomarkers were then tested in all patients to distinguish no_AHRE from AHRE (receiver operating characteristics analysis). Hsp27, TGFβ1, cystatin C, matrix metalloproteinases MMP-2,-3,-9, albumin, and serum uric acid were not altered in the subgroup. Tissue inhibitors of metalloproteinases (TIMP) -1,-2,-4; NT-proANP, NT-proBNP, IL-6 and serum amyloid protein A were significantly different in AHRE vs. no_AHRE (subgroup and whole cohort), with best discriminatory performance for TIMP-4. Biomarkers performed better than CHADS2-VASc for AHRE discrimination. Intracardial electrograms and medical history from seven AHRE patients suggested atrial tachycardia and not AF (AHRE-AT). Four of the most relevant regulated biomarkers (TIMP-4, TIMP-2, SAA, NT-proBNP) behaved similarly in AHRE-AT and AHRE-AF. NT-proBNP >150 pg/mL indicated an odds ratio of 12.9 for AHRE. Combining two biomarkers significantly improved discrimination of AHRE.. TIMP-4, NT-proANP, NT-proBNP were strongest associated with PAF and AHRE. The discriminatory performance of CHADS2-VASc for PAF was increased by addition of selected biomarkers.

Topics: Aged; Aged, 80 and over; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Causality; Comorbidity; Electrocardiography; Female; Germany; Humans; Incidence; Interleukin-6; Male; Natriuretic Peptide, Brain; Peptide Fragments; Reproducibility of Results; Risk Assessment; Sensitivity and Specificity; Serum Amyloid A Protein; Stroke; Tissue Inhibitor of Metalloproteinase-4; Tissue Inhibitor of Metalloproteinases

Topics: Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Stroke

Objectives Left atrial (LA) low-voltage areas (LVAs) are a strong predictor of atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI). However, a non-invasive method for evaluating LA-LAVs has not been established yet. The objective of our study was to assess the predictive value of the plasma atrial natriuretic peptide (ANP) level for the presence of LA-LVAs in patients with persistent AF (PeAF). Methods Seventy-two PeAF patients underwent an exercise stress test preprocedurally. LA voltage maps were created after PVI. Demographic, clinical and echocardiographic data were recorded. Plasma levels of ANP at baseline (ANP0) and increase induced by exercise (ΔANP) were also measured. Results Compared with patients without LA-LVAs, patients with LA-LVAs had a longer history of AF, higher CHADS2 score and higher ANP0 and lower ΔANP. LA-LVAs extent correlated with duration of AF history, CHADS2 score and ΔANP (R = -0.76, P < 0.01). Only ΔANP independently predicted the presence of LA-LVAs (OR =1.63, P = 0.02). Derived from the ROC curve, ΔANP <55 pg/mL predicted the presence of LA-LVAs with high accuracy (AUC =0.78; 95% CI =0.57-0.87, P < 0.01). Conclusions Exercise-induced secretion of ANP may be used to predict the presence of LA-LVAs in patients with PeAF before catheter ablation.

Topics: Action Potentials; Adult; Aged; Atrial Fibrillation; Atrial Function, Left; Atrial Natriuretic Factor; Biomarkers; Catheter Ablation; Echocardiography; Exercise Test; Heart Atria; Humans; Middle Aged; Predictive Value of Tests

Hemodynamic burden is thought to play a role in valvular atrial fibrillation (AF), but the detailed pathophysiology is unclear. We hypothesized that atrial natriuretic peptide (ANP) tissue levels and amyloid deposits in the left atrial appendage (LAA) were associated with the pre-operative hemodynamic status and post-operative rhythm outcome in patients undergoing a concomitant mitral valve and maze surgery.. We quantified the fibrosis, atrial amyloid deposits, ANP tissue levels, and multiple biomarker proteins (Western blot) in LAA tissues taken from 26 patients (53.8% male, 58.4±9.7 years) who underwent concomitant maze and mitral valve surgery. The histologic and biochemical results were compared with the pre-operative pulmonary artery pressure (PAP) and post-operative rhythm outcome.. The ANP tissue level was positively correlated with the atrial amyloid deposit areas (R=0.880, p<0.001), but not with the degree of fibrosis. The pre-operative systolic PAP negatively correlated with both the ANP tissue expression level (R=-0.467, p=0.019) and atrial amyloid deposit area (R=-0.589, p=0.008). The angiotensin II tissue expression level was significantly higher in tissues without ANP expression than in those with expression (p=0.003). AF recurrence after the maze operation was significantly lower in patients without than in those with ANP expression (log rank p=0.031, HR 3.779, 95% CI 1.163-12.277, p=0.027).. A lower ANP atrial tissue expression and amyloid deposits were correlated with a high pre-operative hemodynamic loading, and those patients had a paradoxically lower AF recurrence after relief of the hemodynamic burden by concomitant maze and mitral valve surgery.

Topics: Aged; Amyloid; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Cardiac Surgical Procedures; Female; Fibrosis; Heart Atria; Hemodynamics; Humans; Male; Middle Aged; Mitral Valve; Postoperative Period; Recurrence

The impact of atrial natriuretic peptide (ANP) value for predicting paroxysmal atrial fibrillation (pAF) in ischemic stroke patients remains uncertain.. The consecutive 222 ischemic stroke patients (median 77 [IQR 68-83] years old, 93 females) within 48 hours after onset were retrospectively studied. Plasma ANP and brain natriuretic peptide (BNP) levels were simultaneously measured at admission. Of all, 158 patients had no evidence of atrial fibrillation (AF) (sinus rhythm [SR] group), 25 patients had pAF (pAF group), and the other 39 patients had chronic AF (cAF group). We investigated predicting factors for pAF, with focus on ANP, BNP, and ANP/BNP ratio.. ANP value was significantly higher in the pAF than in the SR group (97 [50-157] mg/dL versus 42 [26-72] mg/dL, P < .05) and further increased in the cAF group (228 [120-392], P < .05 versus pAF and SR groups). Similarly, the BNP value was higher in the pAF than in the SR group (116 [70-238] mg/dL versus 34 [14-72] mg/dL, P < .05) and further increased in the cAF group (269 [199-423], P < .05 versus pAF and SR groups). ANP/BNP ratio was lower in the pAF and cAF groups than in the SR group (.6 [.5-1.2] and .7 [.5-1.0] versus 1.3 [.8-2.4], both P < .05]. Multivariate analysis in the SR and pAF groups (n = 183) demonstrated that age, congestive heart failure, ANP, and BNP, but not ANP/BNP ratio, were independent predictors for detecting pAF. Receiver operating characteristic curve analysis further showed that area under the curve was similar between ANP and BNP (.76 and .80).. ANPmay be clinically useful for detecting pAF in ischemic stroke patients as well as BNP.

Topics: Aged; Aged, 80 and over; Atrial Fibrillation; Atrial Natriuretic Factor; Brain Ischemia; Female; Humans; Male; Multivariate Analysis; Predictive Value of Tests; Retrospective Studies; ROC Curve; Severity of Illness Index; Stroke

Atrial fibrillation (AF) may present variously in time, and AF may progress from self-terminating to non-self-terminating AF, and is associated with impaired prognosis. However, predictors of AF types are largely unexplored. We investigate the clinical, biomarker, and genetic predictors of development of specific types of AF in a community-based cohort.. We included 8042 individuals (319 with incident AF) of the PREVEND study. Types of AF were compared, and multivariate multinomial regression analysis determined associations with specific types of AF.. Mean age was 48.5 ± 12.4 years and 50% were men. The types of incident AF were ascertained based on electrocardiograms; 103(32%) were classified as AF without 2-year recurrence, 158(50%) as self-terminating AF, and 58(18%) as non-self-terminating AF. With multivariate multinomial logistic regression analysis, advancing age (P< 0.001 for all three types) was associated with all AF types, male sex was associated with AF without 2-year recurrence and self-terminating AF (P= 0.031 and P= 0.008, respectively). Increasing body mass index and MR-proANP were associated with both self-terminating (P= 0.009 and P< 0.001) and non-self-terminating AF (P= 0.003 and P< 0.001). The only predictor associated with solely self-terminating AF is prescribed anti-hypertensive treatment (P= 0.019). The following predictors were associated with non-self-terminating AF; lower heart rate (P= 0.018), lipid-lowering treatment prescribed (P= 0.009), and eGFR <60 mL/min/1.73 m2 (P= 0.006). Three known AF-genetic variants (rs6666258, rs6817105, and rs10821415) were associated with self-terminating AF.. We found clinical, biomarker and genetic predictors of specific types of incident AF in a community-based cohort. The genetic background seems to play a more important role than modifiable risk factors in self-terminating AF.

Topics: Adult; Age Factors; Albuminuria; Aminopeptidases; Antihypertensive Agents; Atrial Fibrillation; Atrial Natriuretic Factor; Blood Glucose; Body Mass Index; C-Reactive Protein; Cohort Studies; Creatinine; Cystatin C; Female; Genetic Predisposition to Disease; Glomerular Filtration Rate; Heart Rate; Homeobox Protein PITX2; Homeodomain Proteins; Humans; Hypertension; Hypolipidemic Agents; Logistic Models; Male; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain; Obesity; Peptide Fragments; Phosphotransferases (Phosphate Group Acceptor); Polymorphism, Single Nucleotide; Risk Factors; Sex Factors; Small-Conductance Calcium-Activated Potassium Channels; Transcription Factors

Topics: Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Atrial Remodeling; Biomarkers; Blood Pressure; Cardiomyopathy, Hypertrophic; Case-Control Studies; Catheter Ablation; Female; Heart Atria; Heart Diseases; Humans; Hypertension; Imaging, Three-Dimensional; Male; Middle Aged; Natriuretic Peptide, Brain; Pulmonary Veins; Tomography, X-Ray Computed; Troponin T; Vascular Remodeling

Heterozygous p.(Ser64Arg) mutation in the natriuretic peptide precursor A gene has been associated with atrial fibrillation in the presence of common single nucleotide polymorphisms (rs10033464 and rs2200733; 4q25) that would act as modifiers.. We screened natriuretic peptide precursor A gene in 583 individuals and identified three unrelated carriers of the p.(Ser64Arg) mutation (0.5%).. Only one of the three mutation carriers had episodes of atrial fibrillation. Cascade screening of the three families identified seven additional mutation carriers, none showing atrial fibrillation. The patients with atrial fibrillation also carried the rs2200733, which was however found in four additional nonatrial fibrillation family members and carriers of the p.(Ser64Arg). The prevalence of atrial fibrillation in p.(Ser64Arg) carriers was 10% and in those combining the mutation with the risk single nucleotide polymorphisms was 20%. In the unique mutated patient with atrial fibrillation, the arrhythmias was refractory to both pharmacological and ablation treatment, during 16 years of follow-up; his electrophysiological phenotype was characterized by short atrial cycle lengths with a median value of 131 ms that suggests shortening of atrial action potential.. The prevalence of p.(Ser64Arg) mutation is low in the general population as is the prevalence of atrial fibrillation in mutation carriers (1/10). Atrial fibrillation in the affected mutated patient was lone at onset and progressively evolved with peculiar electrophysiological patterns.

Topics: Atrial Fibrillation; Atrial Natriuretic Factor; Cross-Sectional Studies; Humans; Italy; Prevalence

The myocardium of the right and left atrial appendages (auricles) in patients with paroxysmal, persistent, and permanent forms of atrial fibrillation was examined by histological methods and electron microscopy. Isolated atrial amyloidosis was detected in the left (50.0-56.3% patients) and in the right (45.0-55.6% patients) atrial appendages. In all cases, immunohistochemistry revealed atrial natriuretic peptide in fibrillary amyloid deposits. Ultrastructurally, amyloid masses formed clusters of myofibrils 8-10 nm in diameter. They were chaotically located in the extracellular space along the sarcolemma as well as in membrane invaginations, dilated tubules of cardiomyocyte T-tubular system, and vascular walls. Amyloidosis was predominantly observed in women; its degree positively correlated with age of patients and duration of atrial fibrillation but negatively correlated with atrial fibrosis. The study revealed positive (in permanent atrial fibrillation) and negative (in paroxysmal atrial fibrillation) correlation of amyloidosis with myofibril content in atrial cardiomyocytes.

Topics: Adult; Aged; Amyloid; Amyloidosis; Atrial Fibrillation; Atrial Natriuretic Factor; Female; Heart Atria; Humans; Male; Middle Aged; Myocardium; Young Adult

There is limited knowledge on the short-term influence of radiofrequency ablation (RFA) of atrial fibrillation (AF) on 2 cardiac biomarkers; the N-terminal pro-B-type natriuretic peptide (NT-proBNP) and the midregional fragment of the N-terminal of pro-ANP (MR-proANP) and 2 extracardiac biomarkers; the c-terminal provasopressin (copeptin) and the midregional portion of proadrenomedullin (MR-proADM). There are also limited data concerning cardiac production of the latter two.. We studied 192 consecutive patients eligible for RFA of AF referred to the University Hospital, Linköping, Sweden. NT-proBNP, MR-proANP, copeptin, and MR-proADM levels were measured in peripheral blood, the coronary sinus (CS), and the left atrium before ablation, and in peripheral blood immediately and the day after RFA. The level of NT-proBNP decreased the day after RFA in participants in AF at the time of RFA, compared to the participants in sinus rhythm who showed a slight increase (P<0.001). Furthermore, regardless of the actual rhythm, the level of MR-proANP showed an increase immediately after RFA (P<0.001), followed by a decrease the day after ablation (P<0.001). Copeptin level showed a 6-fold increase immediately after RFA compared to baseline (P<0.001), whereas MR-proADM level increased the day after RFA (P<0.001). Levels of copeptin and MR-proADM were not higher in the CS compared to peripheral blood.. RFA of AF is a strong stimulus with a significant and direct impact on different neurohormonal systems. We found no sign of a cardiac release of MR-proADM or copeptin.. URL: http://www.clinicaltrials.gov. Unique Identifier: NCT01553045.

Topics: Adrenomedullin; Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Catheter Ablation; Cohort Studies; Female; Glycopeptides; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Protein Precursors; Sweden; Treatment Outcome

To investigate the effects of the angiotensin-(1-7) signaling pathway and the possible role of atrial natriuretic peptide (ANP) on atrial electrical remodeling in canines with acute atrial tachycardia.. Forty dogs were randomly assigned to eight groups (five dogs/group): sham, paced control, paced + angiotensin-(1-7), paced + angiotensin-(1-7) + Mas inhibitor, paced + angiotensin-(1-7) + Akt inhibitor, paced + angiotensin-(1-7) + PI3K inhibitor, paced + angiotensin-(1-7) + nitric oxide (NO) inhibitor, and paced + angiotensin-(1-7) + A-71915 (ANP receptor antagonist). Rapid atrial pacing was maintained at 600 bpm for 2 h for all groups, except the sham group, and angiotensin-(1-7) (6 μg kg(-1) h(-1)), Mas inhibitor (5.83 μg kg(-1) h(-1)), Akt inhibitor (2.14 μg kg(-1) h(-1)), PI3K inhibitor (2.86 μg kg(-1) h(-1)), NO synthase inhibitor (180 μg kg(-1)h(-1)), or A-71915 (0.30 μg kg(-1) h(-1)) were administered intravenously. Atrial effective refractory periods, inducibility, and duration of atrial fibrillation (pacing cycle lengths: 300, 250, and 200 ms), and left atrial ANP concentrations were measured.. After pacing, the atrial effective refractory periods at the six sites shortened with increased inducibility and duration of atrial fibrillation, which was attenuated by angiotensin-(1-7), and increased ANP concentrations, which was promoted by angiotensin-(1-7) (paced control vs. sham; P < 0.05). All inhibitors and A-71915 blocked the electrophysiological effects of angiotensin-(1-7). ANP secretion induced by angiotensin-(1-7) was also blocked by all inhibitors.. Angiotensin-(1-7) prevented acute electrical remodeling in canines with acute atrial tachycardia via the angiotensin-(1-7)/Mas/PI3K/Akt/NO signaling pathway. ANP was related to the anti-arrhythmic effects of angiotensin-(1-7).

Topics: Acute Disease; Angiotensin I; Animals; Atrial Fibrillation; Atrial Natriuretic Factor; Disease Models, Animal; Dogs; Heart Atria; Hemodynamics; Nitric Oxide; Peptide Fragments; Phosphatidylinositol 3-Kinases; Proto-Oncogene Mas; Proto-Oncogene Proteins; Proto-Oncogene Proteins c-akt; Receptors, G-Protein-Coupled; Refractory Period, Electrophysiological; Signal Transduction; Tachycardia; Time Factors

Topics: Adult; Age Factors; Area Under Curve; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Case-Control Studies; Confidence Intervals; Diagnosis, Differential; Electrocardiography; Female; Hospitals, University; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Retrospective Studies; Risk Assessment; Singapore; Tachycardia, Paroxysmal

Topics: Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Humans; Natriuretic Peptide, Brain; Probability; Treatment Outcome

Plasma norepinephrine (NE) level can be a guide to mortality in patients with heart failure. This study aimed to evaluate the significance of plasma NE level compared with plasma natriuretic peptides (atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP)) levels in patients with atrial fibrillation (AF).. Included in this study were 137 consecutive patients referred for catheter ablation of lone AF (paroxysmal in 90 and persistent in 47 patients). Blood samples for measurements of ANP, BNP and NE were drawn in the supine position before the procedure.. ANP, BNP and NE levels were greater in patients with persistent AF than in patients with paroxysmal AF (median (25th-75th centile)=28 (18-49) vs 69 (36-106), p<0.0001; 28 (15-50) vs 94 (39-156), p<0.0001; and 315 (223-502) vs 382 (299-517) pg/mL, p=0.04, respectively). NE level correlated weakly with ANP and BNP levels (r=0.28 and r=0.23, respectively, p<0.01 for both). BNP and NE levels differed between patients with and without recurrence of AF (55 (26-135) vs 35 (18-64), p=0.005 and 431 (323-560) vs 302 (225-436) pg/mL, p<0.001, respectively). Of note, only NE level was significantly greater in patients with symptomatic sick sinus syndrome (SSS) (n=21) than in those without SSS (560 (466-632) vs 321 (242-437) pg/mL, p<0.0001). Logistic regression analysis showed NE level to be the only independent discriminator for SSS (OR 1.006, 95% CI 1.002 to 1.010, p=0.001).. An increase in plasma NE level was observed in patients with AF and SSS. Although this implies a pathophysiological link between clinical manifestation of SSS and the autonomic nervous dysfunction, further studies are needed to clarify the mechanisms for this novel finding.

Topics: Aged; Area Under Curve; Atrial Fibrillation; Atrial Natriuretic Factor; Autonomic Nervous System; Biomarkers; Catheter Ablation; Female; Humans; Logistic Models; Male; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain; Norepinephrine; Odds Ratio; Predictive Value of Tests; Recurrence; Risk Factors; ROC Curve; Sick Sinus Syndrome; Treatment Outcome; Up-Regulation

To evaluate the effect of transcatheter closure of the left atrial appendage (LAA) with the Watchman device on the secretion of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP).. The LAA plays an important role in the regulation of intravascular volume via release of ANP and BNP. To date, there are no data suggesting substantial effects of hormonal interaction after percutaneous LAA closure for prevention of thromboembolic events in patients with non-valvular atrial fibrillation.. From October 2009 until May 2010, transcatheter LAA closure using the Watchman device was performed in 31 patients with non-valvular atrial fibrillation. Venous blood samples were obtained before, immediately after device implantation, and prior to discharge for ANP and BNP measurements.. LAA closure resulted in a significant increase in ANP and BNP levels immediately after the procedure compared with baseline measurements (ANP: from 241 ± 34 pg/mL to 329 ± 30 pg/mL, P<.05; BNP: from 579 ± 196 pg/mL to 698 ± 211 pg/mL, P<.05), and a significant decrease prior to discharge compared with baseline values (ANP: from 241 ± 34 pg/mL to 149 ± 30 pg/mL, P<.001; BNP: from 579 ± 196 pg/mL to 429 ± 147 pg/mL, P<.001).. These results suggest that percutaneous closure of the LAA results in an intermittent distribution of the vasoactive hormones ANP and BNP followed by a significant attenuation of ANP and BNP secretion in the early postprocedural period. The clinical impacts of these findings need to be evaluated in further studies.

Topics: Aged; Atrial Appendage; Atrial Fibrillation; Atrial Natriuretic Factor; Cardiac Catheterization; Cardiac Surgical Procedures; Echocardiography, Transesophageal; Equipment Design; Female; Follow-Up Studies; Humans; Male; Natriuretic Peptide, Brain; Retrospective Studies; Treatment Outcome

Atrial fibrillation (AF) is the most common arrhythmia in the general population. There are numerous factors associated with the incidence and relapse of AF. It seems that some of them, such as neurohumoral changes, may affect AF-related atrial structural remodeling and lead to recurrence of AF.. The study aimed to assess the predictive value of plasma brain natriuretic peptide (BNP), atrial natriuretic peptide (ANP), aldosterone (ALD), and endothelin 1 (ET-1) concentrations before and after electrical cardioversion (CV).. The study included 60 patients with a dual-chamber pacemaker, persistent AF, and preserved left ventricular function who underwent successful CV. Blood samples were collected before and 24 hours and 7 days after CV. Recurrence of AF was identified by pacemaker logs lasting 30 minutes or longer.. During a 12-month follow-up, only 5 patients (8%) had no recurrence of AF. Before cardioversion, ANP, ALD, and ET-1 levels were the same as those observed in the control group. BNP levels were significantly elevated and the level of 1237 fmol/ml or higher differentiated between patients with and without the recurrence of AF (sensitivity, 68%; specificity, 67%). Sinus rhythm restoration resulted in a significant decrease only in the BNP level. The BNP level of 700 fmol/ml or higher on day 7 after cardioversion was the most predictive for AF recurrence (sensitivity, 78%; specificity, 71%). In a multivariate analysis, only BNP levels of 700 fmol/ml or higher on day 7 after cardioversion (P = 0.04) and lack of amiodarone (P = 0.03) were independent predictors of AF recurrence.. A BNP level of 700 fmol/ml or higher 7 days after cardioversion is an independent predictor of AF recurrence during 12 months after cardioversion. ANP, ALD, and ET-1 levels at baseline or 7 days after cardioversion are not predictive of AF recurrence.

Topics: Aged; Aged, 80 and over; Aldosterone; Atrial Fibrillation; Atrial Natriuretic Factor; Electric Countershock; Endothelin-1; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Prognosis; Recurrence; Sensitivity and Specificity

NPPA mutations/polymorphisms were associated with atrial fibrillation (AF), and plasma proatrial natriuretic peptide (proANP) concentrations were increased in AF patients. Corin, as a transmembrane protease that processes proANP in the heart, may play a potential role in AF.. To test whether corin concentrations are altered in AF patients, we used ELISA to measure corin and N-terminal proANP (NT-proANP) concentrations in plasma samples from control (n=127) and AF patients (n=141), including paroxysmal AF (PAF, n=83) and persistent AF (PeAF, n=58).. In patients with AF, plasma corin concentrations were 1209±510pg/ml, which were significantly higher than in the controls (973±528pg/ml, P<0.001). The increased plasma corin concentrations were found in both male and female patients. Plasma NT-proANP concentrations in AF patients were 3.1±2.42nmol/l, which were higher than in the controls (1.77±1.04nmol/l, P<0.001). Gender (P=0.003), weight (P=0.016) and PR interval (P=0.028) were independent predictors of plasma corin concentrations in AF patients. A positive correlation was found between corin concentrations and left atrial diameter/PR interval in AF patients.. High plasma corin concentrations in AF patients suggest that corin may play an important role in the pathology of AF.

Topics: Atrial Fibrillation; Atrial Natriuretic Factor; Case-Control Studies; Electrocardiography; Female; Heart Atria; Humans; Male; Middle Aged; Organ Size; Protein Precursors; Serine Endopeptidases

Atrial natriuretic peptide (ANP) is a hormone with numerous beneficial cardiovascular effects. Recently, a mutation in the ANP gene, which results in the generation of a mutant form of ANP (mANP), was identified and shown to cause atrial fibrillation in people. The mechanism(s) through which mANP causes atrial fibrillation is unknown. Our objective was to compare the effects of wild-type ANP and mANP on atrial electrophysiology in mice and humans.. Action potentials (APs), L-type Ca(2+) currents (ICa,L), and Na(+) current were recorded in atrial myocytes from wild-type or natriuretic peptide receptor C knockout (NPR-C(-/-)) mice. In mice, ANP and mANP (10-100 nmol/L) had opposing effects on atrial myocyte AP morphology and ICa,L. ANP increased AP upstroke velocity (Vmax), AP duration, and ICa,L similarly in wild-type and NPR-C(-/-) myocytes. In contrast, mANP decreased Vmax, AP duration, and ICa,L, and these effects were completely absent in NPR-C(-/-) myocytes. ANP and mANP also had opposing effects on ICa,L in human atrial myocytes. In contrast, neither ANP nor mANP had any effect on Na(+) current in mouse atrial myocytes. Optical mapping studies in mice demonstrate that ANP sped electric conduction in the atria, whereas mANP did the opposite and slowed atrial conduction. Atrial pacing in the presence of mANP induced arrhythmias in 62.5% of hearts, whereas treatment with ANP completely prevented the occurrence of arrhythmias.. These findings provide mechanistic insight into how mANP causes atrial fibrillation and demonstrate that wild-type ANP is antiarrhythmic.

Topics: Action Potentials; Animals; Atrial Fibrillation; Atrial Natriuretic Factor; Cardiac Pacing, Artificial; Electrophysiological Phenomena; Heart Atria; Humans; Mice; Mice, Knockout; Myocytes, Cardiac

Atrial fibrillation (AF) is the most common cardiac arrhythmia at the clinic. Recent GWAS identified several variants associated with AF, but they account for <10% of heritability. Gene-gene interaction is assumed to account for a significant portion of missing heritability. Among GWAS loci for AF, only three were replicated in the Chinese Han population, including SNP rs2106261 (G/A substitution) in ZFHX3, rs2200733 (C/T substitution) near PITX2c, and rs3807989 (A/G substitution) in CAV1. Thus, we analyzed the interaction among these three AF loci. We demonstrated significant interaction between rs2106261 and rs2200733 in three independent populations and combined population with 2,020 cases/5,315 controls. Compared to non-risk genotype GGCC, two-locus risk genotype AATT showed the highest odds ratio in three independent populations and the combined population (OR=5.36 (95% CI 3.87-7.43), P=8.00×10-24). The OR of 5.36 for AATT was significantly higher than the combined OR of 3.31 for both GGTT and AACC, suggesting a synergistic interaction between rs2106261 and rs2200733. Relative excess risk due to interaction (RERI) analysis also revealed significant interaction between rs2106261 and rs2200733 when exposed two copies of risk alleles (RERI=2.87, P<1.00×10-4) or exposed to one additional copy of risk allele (RERI=1.29, P<1.00×10-4). The INTERSNP program identified significant genotypic interaction between rs2106261 and rs2200733 under an additive by additive model (OR=0.85, 95% CI: 0.74-0.97, P=0.02). Mechanistically, PITX2c negatively regulates expression of miR-1, which negatively regulates expression of ZFHX3, resulting in a positive regulation of ZFHX3 by PITX2c; ZFHX3 positively regulates expression of PITX2C, resulting in a cyclic loop of cross-regulation between ZFHX3 and PITX2c. Both ZFHX3 and PITX2c regulate expression of NPPA, TBX5 and NKX2.5. These results suggest that cyclic cross-regulation of gene expression is a molecular basis for gene-gene interactions involved in genetics of complex disease traits.

Topics: 3' Untranslated Regions; Atrial Fibrillation; Atrial Natriuretic Factor; Base Sequence; Binding Sites; Case-Control Studies; Caveolin 1; Epistasis, Genetic; Gene Expression; Genetic Predisposition to Disease; Genome-Wide Association Study; Homeobox Protein Nkx-2.5; Homeobox Protein PITX2; Homeodomain Proteins; Humans; MicroRNAs; Polymorphism, Single Nucleotide; RNA Interference; Transcription Factors

Lyme disease is found in a majority of people we tested. Once Borrelia Burgdorferi (B.B.) spirochete enters human body, it not only causes pain by infecting joints, but it also often enters the brain and the heart. Infection of brain can be quickly detected from the pupil and infection of the heart by ECGs non-invasively. By evaluating recorded ECGs of atrial fibrillation (AF), using U.S. patented non-invasive highly sensitive electromagnetic field (EMF) resonance phenomenon between 2 identical molecules or between a molecule and its antibody, we examined 25 different AF patients' ECGs and found the majority of them suffer from various degrees of B.B. spirochete infection in SA node areas, also in the right & left atria, and pulmonary vein near and around its junction at left atrium & lesser degrees of infection at the AV node & His Bundle. When B.B. infection reaches over 224-600ng or higher at these areas, AF often appears in the majority of all AF analyzed. In order to develop AF, the 4 abnormal factors must be present simultaneously: 1) B.B. infection must be increased to 224-600ng or higher, 2) Atrial Natriuretic Peptide (ANP) must be markedly reduced from normal value of less than 4ng to over 100-400ng, 3) A significant increase of Cardiac Troponin I from normal value of less than 3ng to over 12ng and 4) Taurine must also be markedly reduced from normal value of 4-6ng to 0.25ng. These 4 changes were mainly found only at infected sites of the SA node area, both atria and between the end of the T wave & the beginning of the SA node area, which corresponds to U waves at recorded ECG. Origin of the U wave is mainly due to abnormal electrical potential of pulmonary vein at L-atrium. If all 4 factors do not occur at the infection site, no AF will develop. In seemingly normal ECGs, if using this method, one can detect invisible B.B. infection in early stages. Long before AF appears, AF can be prevented by improved treatment with Amoxicillin 500ng 3 times/day + Taurine 175mg x 3 times/day, with or without EPA 180 mg & DHA 120 mg, to avoid serious current limitations in the use of Doxycycline 100 mg 2 times/day, for 4 weeks.

Topics: Atrial Fibrillation; Atrial Natriuretic Factor; Borrelia burgdorferi; Electrocardiography; Heart Atria; Humans; Lyme Disease; Pulmonary Veins; Sinoatrial Node; Taurine; Troponin I

Atrial fibrillation is one of the most common arrhythmias in clinical practice and it is often diagnosed after a complication occurs. The study aimed to evaluate the predictive value of atrial natriuretic peptide (ANP) for atrial fibrillation in a male population-based study.. This study is a part of the "Study of Men Born in 1913 and 1923", a longitudinal prospective cohort study of men, living in the city of Gothenburg in Sweden. A population-based sample of 528 men was investigated in 1988 when they were aged 65 years (n=134) and 75 years (n=394), and they were followed up for 16 years. Blood samples were collected from all 528 men at baseline and plasma ANP levels were analyzed by radioimmunoassay. Hazard ratios were estimated by competing-risk regression analysis. One hundred five participants were excluded because of a prior diagnosis of atrial fibrillation, congestive heart failure, severe hypertension, or severe chronic renal insufficiency. Of the remaining 423 participants, 90 men were diagnosed with atrial fibrillation over the 16-year follow-up. In multivariable analysis, men in the two highest quartiles of ANP levels had a significantly higher risk for atrial fibrillation compared with men in the lowest ANP quartile. The adjusted ratio was 3.14 (95% CI 1.59-6.20) for the third ANP quartile and 3.36 (95% CI 1.72-6.54) for the highest quartile of ANP level.. In this population-based longitudinal study, we found that elevated ANP levels at baseline predicted atrial fibrillation during a follow-up time of 16 years.

Topics: Aged; Aged, 80 and over; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Cohort Studies; Follow-Up Studies; Humans; Longitudinal Studies; Male; Population Surveillance; Prospective Studies; Sweden

The clinical relevance of examining human atrial natriuretic peptide (HANP) or left atrial appendage (LAA) wall-motion velocity during sinus rhythm in paroxysmal atrial fibrillation (AF) patients has not been clearly elucidated.. The subjects were 38 patients with paroxysmal AF who underwent transesophageal and transthoracic echocardiography during sinus rhythm. The presence of spontaneous echocontrast (SEC) was examined with transesophageal echocardiography and LAA wall-motion velocity (LAAWV) was measured with transthoracic tissue Doppler echocardiography. Plasma HANP was measured within 3 hours after echocardiography.. Human atrial natriuretic peptide ranged from 12 to 106 pg/mL with an average of 43 ± 24 pg/mL and had a significant correlation with LAAWV (r = -0.57) or LAA flow velocity (r = -0.41). HANP was significantly higher in patients with SEC than in patients without SEC (64 ± 29 vs. 34 ± 15 pg/mL, P = 0.008) and LAAWV was significantly lower in patients with SEC than in patients without SEC (13 ± 5 vs. 20 ± 5 cm/sec, P = 0.002). HANP >44 pg/mL had a sensitivity of 73% and specificity of 89% for diagnosing SEC. SEC was more frequently observed (73%) in patients with HANP >44 pg/mL and/or LAAWV <10 cm/sec as compared with patients (11%) with normal HANP and LAA wall-motion velocity (P < 0.0001).. Higher plasma HANP and lower LAA wall-motion velocity may be noninvasive surrogate markers for assessing left atrial thrombogenesis during sinus rhythm in paroxysmal AF patients.

Topics: Aged; Atrial Appendage; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Echocardiography; Female; Humans; Male; Prognosis; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Thrombosis

In this study, we assessed the relationship of insular strokes and plasma MR-proANP levels with newly diagnosed atrial fibrillation (NDAF).. This study is based on a prospective acute stroke cohort (http://www.clinicaltrials.gov, NCT00390962). Patient eligibility was dependent on the diagnosis of acute ischemic stroke, absence of previous stroke based on past medical history and MRI, no history of AF and congestive heart failure (cohort A) and, additionally, no stroke lesion size ≥ 20 mL (sub-cohort A*). AF, the primary endpoint, was detected on 24-hour electrocardiography and/or echocardiography. Involvement of the insula was assessed by two experienced readers on MRI blinded to clinical data. MR-proANP levels were obtained through a novel sandwich immunoassay. Logistic-regression-models were fitted to estimate odds ratios for the association of insular strokes and MR-proANP with NDAF. The discriminatory accuracy of insular strokes and MR-proANP was assessed by a model-wise comparison of the area under the receiver-operating-characteristics-curve (AUC) with known predictors of AF.. 104 (cohort A) and 83 (cohort A*) patients fulfilled above-mentioned criteria. Patients with isolated insular strokes had a 10.7-fold higher odds of NDAF than patients with a small ischemic stroke at any other location. The AUC of multivariate logistic regression models for the prediction of NDAF improved significantly when adding stroke location and MR-proANP levels. Moreover, MR-proANP levels remained significantly elevated throughout the acute hospitalization period in patients with NDAF compared to those without.. Isolated insular strokes and plasma MR-proANP levels on admission are independent predictors of NDAF and significantly improve the prediction accuracy of identifying patients with NDAF compared to known predictors including age, the NIHSS and lesion size. To accelerate accurate diagnosis and enhance secondary prevention in acute stroke, higher levels of MR-proANP and insular strokes may represent easily accessible indicators of AF if confirmed in an independent validation cohort.

Topics: Aged; Aged, 80 and over; Atrial Fibrillation; Atrial Natriuretic Factor; Female; Humans; Male; Middle Aged; Pilot Projects; Prospective Studies; Stroke

Although the maze procedure is an established surgical treatment for eliminating atrial fibrillation (AF), its efficacy in patients with mitral valve disease has remained unsatisfactory. A useful predictive marker for the outcome of the maze procedure is needed. The aim of this study was to investigate whether the preoperative ratio of atrial natriuretic peptide (ANP) to brain natriuretic peptide (BNP) reflects atrial fibrosis and can be used to predict the maze procedure outcome in patients with mitral valve disease.. A total of 23 consecutive patients who underwent the radial approach to the maze procedure combined with mitral valve surgery were included in this study and were divided into a sinus rhythm (SR) group (n=16) and an AF group (n=7) based on postoperative cardiac rhythm. Plasma samples were obtained at rest before the operation and were analysed for ANP and BNP levels. Atrial tissue samples taken during surgery were used to quantify interstitial fibrosis.. The preoperative ANP-to-BNP ratio in the SR group was significantly higher than that in the AF group (0.74 +/- 0.29 vs. 0.42 +/- 0.28, respectively; p=0.025). Receiver operating characteristic (ROC) curve analysis was used to identify factors that predict outcomes after the maze procedure. The area under the ROC curve for the ANP-to-BNP ratio (0.81) was greater than for any other preoperative factors. Moreover, the preoperative ANP-to-BNP ratio demonstrated a negative correlation with left atrial fibrosis (r=-0.69; p=0.003).. The preoperative ANP-to-BNP ratio can predict maze procedure outcome in patients with mitral valve disease, and it represents a potential biomarker for left atrial fibrosis.

Topics: Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Cardiac Surgical Procedures; Female; Fibrosis; Heart Atria; Heart Valve Diseases; Humans; Male; Middle Aged; Mitral Valve; Natriuretic Peptide, Brain; ROC Curve; Treatment Outcome

Atrial fibrillation (AF) often occurs in the presence of an underlying disease. These underlying diseases cause atrial remodelling, which make the atria more susceptible to AF. Stretch is an important mediator in the remodelling process. The aim of this study was to develop an atrial cell culture model mimicking remodelling due to atrial pressure overload. Neonatal rat atrial cardiomyocytes (NRAM) were cultured and subjected to cyclical stretch on elastic membranes. Stretching with 1 Hz and 15% elongation for 30 min. resulted in increased expression of immediate early genes and phosphorylation of Erk and p38. A 24-hr stretch period resulted in hypertrophy-related changes including increased cell diameter, reinduction of the foetal gene program and cell death. No evidence of apoptosis was observed. Expression of atrial natriuretic peptide, brain natriuretic peptide and growth differentiation factor-15 was increased, and calcineurin signalling was activated. Expression of several potassium channels was decreased, suggesting electrical remodelling. Atrial stretch-induced change in skeletal α-actin expression was inhibited by pravastatin, but not by eplerenone or losartan. Stretch of NRAM results in elevation of stress markers, changes related to hypertrophy and dedifferentiation, electrical remodelling and cell death. This model can contribute to investigating the mechanisms involved in the remodelling process caused by stretch and to the testing of pharmaceutical agents.

Topics: Actins; Animals; Animals, Newborn; Anticholesteremic Agents; Atrial Fibrillation; Atrial Natriuretic Factor; Atrial Remodeling; Calcineurin; Cell Death; Extracellular Signal-Regulated MAP Kinases; Gene Expression Regulation, Developmental; Growth Differentiation Factor 15; Heart Atria; Myocytes, Cardiac; Natriuretic Peptide, Brain; p38 Mitogen-Activated Protein Kinases; Potassium Channels; Pravastatin; Pressure; Rats; Rats, Sprague-Dawley; Signal Transduction; Stress, Mechanical

We have previously demonstrated that catheter-based renal sympathetic denervation (RSD) could suppress atrial fibrillation (AF) in canines with short-time rapid right atrial pacing (RAP). However, the role of renal denervation on atrial remodeling is unclear. The aim of the present study was to explore the long-term effect of RSD on the atrial remodeling during prolonged RAP. Twenty mongrel dogs were implanted with a high-frequency cardiac pacemaker with a transvenous lead inserted into the right atrial appendage. The dogs were divided into three groups: a sham-operated group (n = 6), the chronic RAP (CRAP) group (n = 7), and the CRAP+RSD group (n = 7). In the CRAP+RSD group, a pacemaker was implanted 6 weeks after RSD was performed bilaterally for recovery. RAP was maintained for 5 weeks in CRAP group and CRAP+RSD group. The plasma levels of Angiotensin II and aldosterone were significantly increased in CRAP group compared with sham-operated group, but the increasing trend was inhibited in CRAP+RSD group compared with CRAP group (P<0.05). Similarly, RSD suppressed the increasing trend that prolonged RAP produced in the left atrial levels of ANP, TNF-α and IL-6. Compared with the sham-operated group, the CRAP group had significantly increased levels of caspase-3, bax and Cx40 whereas the level of Bcl-2 decreased (P<0.05). RSD markedly reduced the upregulation of caspase-3, bax and Cx40 and the downregulation of Bcl-2 expression compared with the CRAP group (P<0.05). Picric acid-sirius red staining study suggested that RSD could markedly alleviate the lesion degree of cardic fibrosis induced by CRAP (P<0.05). Immunohistochemistry results showed that the densities of TH- and GAP43- positive nerves were significantly elevated in the CRAP group compared with the sham-operated group, while RSD operation signicantly inhibited the these changes produced by CRAP. These findings suggest that renal denervation could suppress the atrial remodeling after prolonged RAP in ambulatory canines.

Topics: Aldosterone; Angiotensin II; Animals; Apoptosis; Atrial Fibrillation; Atrial Natriuretic Factor; Atrial Remodeling; Blood Pressure; Cardiac Pacing, Artificial; Dogs; Fibrosis; Gap Junctions; GAP-43 Protein; Heart Atria; Inflammation; Interleukin-6; Kidney; Myocytes, Cardiac; Sympathectomy; Tumor Necrosis Factor-alpha

Despite the evidence that the hyperpolarization-activated current (If) is highly modulated in human cardiomyopathies, no definite data exist in chronic atrial fibrillation (cAF). We investigated the expression, function, and modulation of If in human cAF.. Right atrial samples were obtained from sinus rhythm (SR, n = 49) or cAF (duration >1 year, n = 31) patients undergoing corrective cardiac surgery. Among f-channel isoforms expressed in the human atrium (HCN1, 2 and 4), HCN4 mRNA levels measured by RT-PCR were significantly reduced. However, protein expression was preserved in cAF compared to SR (+85% for HCN4); concurrently, miR-1 expression was significantly reduced. In patch-clamped atrial myocytes, current-specific conductance (gf) was significantly increased in cAF at voltages around the threshold for If activation (-60 to -80 mV); accordingly, a 10-mV rightward shift of the activation curve occurred (P < 0.01). β-Adrenergic and 5-HT4 receptor stimulation exerted similar effects on If in cAF and SR cells, while the ANP-mediated effect was significantly reduced (P < 0.02), suggesting downregulation of natriuretic peptide signaling.. In human cAF modifications in transcriptional and posttranscriptional mechanisms of HCN channels occur, associated with a slight yet significant gain-of-function of If , which may contribute to enhanced atrial ectopy.

Topics: Action Potentials; Adrenergic beta-Agonists; Adult; Aged; Aged, 80 and over; Atrial Fibrillation; Atrial Natriuretic Factor; Chronic Disease; Female; Heart Atria; Humans; Hyperpolarization-Activated Cyclic Nucleotide-Gated Channels; Male; MicroRNAs; Middle Aged; Muscle Proteins; Potassium Channels; RNA Processing, Post-Transcriptional; RNA, Messenger; Serotonin 5-HT4 Receptor Agonists; Transcription, Genetic

The outcome of atrial fibrillation patients with genetic mutations post ablation was not well evaluated.. Three atrial fibrillation patients with evidence of mutations in KCNA5 and NPPA post successful circumferential pulmonary vein ablation were included. Mutation in KCNA5 was found in one male patient with paroxysmal atrial fibrillation. He was free of atrial fibrillation post ablation after 46 months follow-up. Mutations in NPPA were found in two male patients with persistent atrial fibrillation and they were free from atrial fibrillation after 64 months and 38 months follow-up post circumferential pulmonary vein ablation, roof line and mitral isthmus line ablation.. Satisfactory long term results are observed in atrial fibrillation patients with KCNA5 and NPPA mutations post circumferential pulmonary vein ablation.

Topics: Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Catheter Ablation; Follow-Up Studies; Humans; Kv1.5 Potassium Channel; Male; Middle Aged; Mutation; Treatment Outcome

Epicardial ablation concomitant to cardiac surgery is an easy and safe approach to treat atrial fibrillation (AF), but its efficacy in longstanding persistent (LsPe) AF remains intermediate. Although larger left atrial size has been associated with worse outcome after ablation, biochemical predictors of success are not well established. The aim of this study was to evaluate relationship between biochemical marker, echo-characteristic and cardiac rhythm in 6 months follow-up after epicardial ultrasound (HIFU) ablation.. We included 78 consecutive patients, who underwent elective cardiac surgery. 42 patients with AF (11.9% paroxysmal, 23.8% persistent, 64.3% LsPeAF) underwent concomitant HIFU ablation (AF ablation group), 16 with AF underwent cardiac surgery without ablation (AF control) and 20 had preoperatively normal sinus rhythm (SR control). We measured plasma ANP secretion before, on postoperative day (POD) 1, POD 7 as well as 3 and 6 months after surgery. Moreover, we estimated cardiac rhythm and atrial mechanical function by Atrial Filling Fraction (AFF) and A-wave velocity in follow-up.. Baseline ANP levels were higher in patients with LsPeAF, as compared to the paroxysmal and permanent AF and to the SR control group. Patients with LsPeAF (n = 27) who converted to SR had preoperatively smaller left atrial diameter (LAD) and LA area (p < 0.05) and higher ANP level (p = 0.009) than those who remained in AF at 6 months after ablation. Multivariate regression analysis revealed that only preoperative ANP level was an independent predictor of cardiac rhythm after ablation. Patients with LsPeAF and preoperative ANP >7.5 nmol/l presented with SR in 80%, in contrast to those with ANP <7.5 nmol/l who converted to SR in 20%. We detected gradual increase of AFF and A-velocity at 6 months after ablation (p < 0.05) solely in AF ablation group. ANP levels were increased on POD 1 in ablation group (p < 0.05), without changes in further follow-up.. Our results indicate that preoperative ANP levels may be a new biochemical predictor of successful epicardial ablation in patients with concomitant LsPeAF. HIFU ablation caused a significant improvement of atrial mechanical function and gradual increase of AFF and did not associate with alteration of atrial endocrine secretion at 6 months follow-up.

Topics: Aged; Aged, 80 and over; Atrial Fibrillation; Atrial Function; Atrial Natriuretic Factor; Catheter Ablation; Epicardial Mapping; Female; Heart Atria; Heart Function Tests; Humans; Male; Middle Aged; Preoperative Period; Prospective Studies; ROC Curve; Treatment Outcome

The purpose of this study was to assess the impact of atrial fibrillation (AF) on the performance of mid-region amino terminal pro-atrial natriuretic peptide (MR-proANP) in comparison with the B-type peptides (BNP and NT-proBNP) for diagnosis of acute heart failure (HF) in dyspneic patients.. The effects of AF on the diagnostic and prognostic performance of MR-proANP in comparison with the B type natriuretic peptides have not been previously reported.. A total of 1,445 patients attending the emergency department with acute dyspnea had measurements taken of MR-proANP, BNP, and NT-proBNP values on enrollment to the BACH trial and were grouped according to presence or absence of AF and HF.. AF was present in 242 patients. Plasma concentrations of all three peptides were lowest in those with neither AF nor HF and AF without HF was associated with markedly increased levels (p < 0.00001). HF with or without AF was associated with a significant further increment (p < 0.00001 for all three markers). Areas under receiver operator characteristic curves (AUCs) for discrimination of acute HF were similar and powerful for all peptides without AF (0.893 to 0.912; all p < 0.001) with substantial and similar reductions (0.701 to 0.757) in the presence of AF. All 3 peptides were independently prognostic but there was no interaction between any peptide and AF for prediction of all-cause mortality.. AF is associated with increased plasma natriuretic peptide (MR-proANP, BNP and NT-proBNP) levels in the absence of HF. The diagnostic performance of all three peptides is impaired by AF. This warrants consideration of adjusted peptide thresholds for diagnostic use in AF and mandates the continued search for markers free of confounding by AF.

Topics: Acute Disease; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Dyspnea; Female; Heart Failure; Humans; Male; Middle Aged; Predictive Value of Tests; Prospective Studies

Topics: Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Female; Heart Failure; Humans; Male; Natriuretic Peptide, Brain; Peptide Fragments; Shock, Cardiogenic

An irregular ventricular response during atrial fibrillation (AF) has been shown to mediate an increase in sympathetic nerve activity in human subjects. The molecular mechanisms remain unclear. This study aimed to investigate the impact of rate and irregularity on nerve growth factor (NGF) expression in cardiomyocytes, since NGF is known to be the main contributor to cardiac sympathetic innervation density. Cell cultures of neonatal rat ventricular myocytes were electrically stimulated for 48 h with increasing rates (0, 5 and 50 Hz) and irregularity (standard deviation (SD)=5%, 25% and 50% of mean cycle length). Furthermore, we analyzed the calcineurin-NFAT and the endothelin-1 signalling pathways as possible contributors to NGF regulation during arrhythmic stimulation. We found that the increase of NGF expression reached its maximum at the irregularity of 25% SD by 5 Hz (NGF: 5 Hz 0% SD=1 vs. 5Hz 25% SD=1.57, P<0.05). Specific blockade of the ET-A receptor by BQ123 could abolish this NGF increase (NGF: 5 Hz 25% SD+BQ123=0.66, P<0.05). High frequency electrical field stimulation (HFES) with 50 Hz decreased the NGF expression in a significant manner (NGF: 50Hz=0.55, P<0.05). Inhibition of calcineurin-NFAT signalling with cyclosporine-A or 11R-VIVIT abolished the HFES induced NGF down-regulation (NGF: 50 Hz+CsA=1.14, P<0.05). In summary, this study reveals different signalling routes of NGF expression in cardiomyocytes exposed to increasing rates and irregularity. Whether this translates into different degrees of NGF expression and possibly neural sympathetic growth in various forms of ventricular rate control during AF remains to be elucidated in further studies.

Topics: Animals; Atrial Fibrillation; Atrial Natriuretic Factor; Calcineurin; Cell Nucleus; Cells, Cultured; Culture Media, Conditioned; Electric Stimulation; Endothelin A Receptor Antagonists; Endothelin-1; Gene Expression Regulation; Heart Ventricles; Myocytes, Cardiac; Nerve Growth Factor; Neurites; NFATC Transcription Factors; Peptides, Cyclic; Primary Cell Culture; Rats; Signal Transduction; Transcription, Genetic

The purpose of this study is to evaluate the relationship between plasma high-sensitivity C-reactive protein (hs-CRP), atrial natriuretic peptides (ANP), N-terminal-pro-brain natriuretic peptide (NT-proBNP) levels, and the risk and recurrence of atrial fibrillation (AF) after pulmonary vein isolation (PVI) in patients with paroxysmal atrial fibrillation (PAF).. Plasma ANP, NT-proBNP, and hs-CRP levels were measured before and 3 months after PVI in 33 patients with PAF and 30 control participants.. (1) NT-proBNP levels at baseline were significantly elevated in subjects with PAF compared with control subjects (296.8 ± 272.1 vs. 80.8 ± 69.1 pg/ml), but ANP and hs-CRP levels were normal; NT-proBNP levels normalized 3 months after PVI, but ANP and hs-CRP levels did not change significantly; NT-proBNP levels at baseline in the recurrent group were markedly higher than those in the nonrecurrent AF group (572.7 ± 234.2 vs. 176.8 ± 188.7 pg/ml). (2) Cox stepwise multivariate analysis demonstrated that only elevated NT-proBNP level at baseline was an independent predictor of AF recurrence (p < 0.001) after PVI among 13 variables, such as echocardiographic parameters, plasma ANP, NT-proBNP, and hs-CRP levels. A cutoff value of NT-proBNP ≥ 423.2 pg/ml was a significant risk factor for AF recurrence (p = 0.002).. Elevated NT-proBNP level at baseline, but not ANP and hs-CRP, is a sensitive biomarker for early predicting AF recurrence in patients with PAF.

Topics: Adult; Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; C-Reactive Protein; Catheter Ablation; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Pulmonary Veins; Recurrence

Long-term endurance sports are associated with atrial remodeling and an increased risk for atrial fibrillation (AF) and atrial flutter. Pro-atrial natriuretic peptide (pro-ANP) is a marker of atrial wall tension and elevated in patients with AF. The aim of this study was to test the hypothesis that atrial remodeling would be perpetuated by repetitive episodes of atrial stretching during strenuous competitions, reflected by elevated levels of pro-ANP. A cross-sectional study was performed on nonelite runners scheduled to participate in the 2010 Grand Prix of Bern, a 10-mile race. Four hundred ninety-two marathon and nonmarathon runners applied for participation, 70 were randomly selected, and 56 entered the final analysis. Subjects were stratified according to former marathon participations: a control group (nonmarathon runners, n = 22), group 1 (1 to 4 marathons, n = 16), and group 2 (≥5 marathons, n = 18). Results were adjusted for age, training years, and average weekly endurance training hours. The mean age was 42 ± 7 years. Compared to the control group, marathon runners in groups 1 and 2 had larger left atria (25 ± 6 vs 30 ± 6 vs 34 ± 7 ml/m(2), p = 0.002) and larger right atria (27 ± 7 vs 31 ± 8 vs 35 ± 5 ml/m(2), p = 0.024). Pro-ANP levels at baseline were higher in marathon runners (1.04 ± 0.38 vs 1.42 ± 0.74 vs 1.67 ± 0.69 nmol/L, p = 0.006). Pro-ANP increased significantly in all groups after the race. In multiple linear regression analysis, marathon participation was an independent predictor of left atrial (β = 0.427, p <0.001) and right atrial (β = 0.395, p = 0.006) remodeling. In conclusion, marathon running was associated with progressive left and right atrial remodeling, possibly induced by repetitive episodes of atrial stretching. The altered left and right atrial substrate may facilitate atrial arrhythmias.

Topics: Adult; Algorithms; Atrial Fibrillation; Atrial Flutter; Atrial Natriuretic Factor; Biomarkers; Case-Control Studies; Cross-Sectional Studies; Heart Atria; Humans; Male; Middle Aged; Physical Endurance; Regression Analysis; Risk Factors; Running

We propose to assess the value of exercise-induced change in N-terminal-pro atrial natriuretic peptide (NT-proANP) and left atrial expansion index (LAEI) in predicting AFR after cardioversion and their effect on AF-free survival.. Fifty-five patients with persistent AF of <18 months duration needing cardioversion were recruited for the study. Fifty-four patients were successfully cardioverted. At 3 months 28/54 (51%) were in SR and at 12 months 21/53 (39%). On multivariate analysis, only exercise-induced change in NT-proANP and LAEI were found to be predictive of AFR up to 12 months post-cardioversion and had an effect on AF-free survival. N-terminal-pro brain natriuretic peptide was elevated in all persistent AF patients but did not predict recurrent AF.. Left atrial expansion index and exercise-induced atrial natriuretic peptide change show promise as predictors of AFR after cardioversion. These predictors may identify patients at an early stage in their disease with intact neurohumoral feedback systems and less advanced atrial remodelling. Further studies are required to confirm these findings.

Topics: Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Disease-Free Survival; Electric Countershock; Electrocardiography; Exercise; Female; Heart Atria; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Organ Size; Predictive Value of Tests; Prognosis; Prospective Studies; Recurrence; Treatment Outcome

Topics: Atrial Fibrillation; Atrial Natriuretic Factor; Exercise; Female; Heart Atria; Humans; Male

Topics: Accidents, Home; Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Atropine; Bradycardia; Cardiac Pacing, Artificial; Cardiotonic Agents; Cold Temperature; Diuresis; Dopamine; Electric Countershock; Electrocardiography; Female; Humans; Hypothermia; Rewarming; Unconsciousness; Vasoconstriction

The aim of this study was to test the hypothesis that 2 common polymorphisms in the chromosome 4q25 region that have been associated with atrial fibrillation (AF) contribute to the variable penetrance of familial AF.. Although mutations in ion channels, gap junction proteins, and signaling molecules have been described for Mendelian forms of AF, penetrance is highly variable. Recent studies have consistently identified 2 common single-nucleotide polymorphisms in the chromosome 4q25 region as independent AF susceptibility alleles.. Eleven families in which AF was present in ≥2 members who also shared a candidate gene mutation were studied. These mutations were identified in all subjects with familial lone AF (n = 33) as well as apparently unaffected family members (age >50 years with no AF; n = 17).. Mutations were identified in SCN5A (n = 6), NPPA (n = 2), KCNQ1 (n = 1), KCNA5 (n = 1), and NKX2.5 (n = 1). In genetic association analyses, unstratified and stratified according to age of onset of AF and unaffected age >50 years, there was a highly statistically significant association between the presence of both common (rs2200733 and rs10033464) and rare variants and AF (unstratified p = 1 × 10(-8), stratified [age of onset <50 years and unaffected age >50 years] p = 7.6 × 10(-5)) (unstratified p < 0.0001, stratified [age of onset <50 years and unaffected age >50 years] p < 0.0001). Genetic association analyses showed that the presence of common 4q25 risk alleles predicted whether carriers of rare mutations developed AF (p = 2.2 × 10(-4)).. Common AF-associated 4q25 polymorphisms modify the clinical expression of latent cardiac ion channel and signaling molecule gene mutations associated with familial AF. These findings support the idea that the genetic architecture of AF is complex and includes both rare and common genetic variants.

Topics: Adult; Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Chromosomes, Human, Pair 4; Cohort Studies; Genetic Predisposition to Disease; Genotype; Homeobox Protein Nkx-2.5; Homeodomain Proteins; Humans; Ion Channels; KCNQ1 Potassium Channel; Kv1.5 Potassium Channel; Middle Aged; Mutation; NAV1.5 Voltage-Gated Sodium Channel; Pedigree; Polymorphism, Single Nucleotide; Prospective Studies; Registries; Transcription Factors

Due to different release mechanisms, mid-regional pro-atrial natriuretic peptide (MR proANP) may be superior to N-terminal pro-B-type natriuretic peptide (NT proBNP) in the diagnosis of acute heart failure (AHF) in patients with atrial fibrillation (AF). We compared MR proANP and NT proBNP for their diagnostic value in patients with AF and sinus rhythm (SR).. Prospective cohort study.. University hospital, emergency department.. 632 consecutive patients presenting with acute dyspnoea.. MR proANP and NT proBNP plasma levels were determined. The diagnosis of AHF was adjudicated by two independent cardiologists using all available data. Patients received long-term follow-up.. AF was present in 151 patients (24%). MR proANP and NT proBNP levels were significantly higher in the AF group compared with the SR group (385 (258-598) versus 201 (89-375) pmol/l for MR proANP, p<0.001 and 4916 (2169-10285) versus 1177 (258-5166) pg/ml, p<0.001 for NT proBNP). Diagnostic accuracy in AF patients was similar for MR proANP (0.90, 95% CI 0.84 to 0.95) and NT proBNP (0.89, 95% CI 0.81 to 0.96). Optimal cut-off levels in AF patients were significantly higher compared with the optimal cut-off levels for patients in SR (MR proANP 240 vs 200 pmol/l; NT proBNP 2670 vs 1500 pg/ml respectively). After adjustment in multivariable Cox proportional hazard analysis, MR proANP strongly predicted one-year all-cause mortality (HR=1.13 (1.09-1.17), per 100 pmol/l increase, p<0.001).. In AF patients, NT proBNP and MR proANP have similar diagnostic value for the diagnosis of AHF. The rhythm at presentation has to be taken into account because plasma levels of both peptides are significantly higher in patients with AF compared with SR.

Topics: Acute Disease; Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Cohort Studies; Dyspnea; Heart Failure; Humans; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prospective Studies; Protein Precursors; Reproducibility of Results

The aim of this study was to investigate the prognostic value of natriuretic peptides and atrial fibrillation (AF) on response to cardiac resynchronization therapy (CRT) and mortality.. This study included 338 consecutive CRT patients. Response to CRT was defined as a reduction in left ventricular end-systolic volume of ≥15% in the absence of death at 6-month follow-up. During follow-up (27 ± 19 months), 139 patients (41%) had AF, being new onset in 40 patients (21%). Forty-two patients (12%) had permanent AF. Response to CRT was observed in 168 of 302 patients (56%): 60 of 123 patients (43%) with AF vs. 108 of 179 patients (60%) without AF (P = 0.047). Low baseline atrial natriuretic peptide (ANP) [odds ratio for log(2) ANP 0.49, 95% confidence interval (CI) 0.35-0.68, P < 0.001] and large left ventricular end-systolic volume (odds ratio for every 50 mL 1.40, 95% CI 1.09-1.79, P = 0.009) were independent predictors of response. Neither the presence of AF nor the increase in AF burden independently predicted response. Ninety patients (27%) died; 50 patients (36%) with AF vs. 40 patients (20%) without AF (log rank P = 0.029). Important predictors of all-cause mortality were new-onset AF (hazard ratio 8.11, 95% CI 3.31-19.85, P < 0.001), permanent AF (hazard ratio 3.19, 95% CI 1.61-6.30, P = 0.001), and baseline N-terminal pro-B-type natriuretic peptide (NT-proBNP) (hazard ratio for log(2) NT-proBNP 0.77, 95% CI 0.66-0.90, P = 0.001).. In patients treated with CRT, lower ANP and larger left ventricular end-systolic volume were independent predictors of response. New-onset AF, permanent AF, and NT-proBNP were independently associated with increased all-cause mortality.

Topics: Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Cardiac Resynchronization Therapy; Female; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Prospective Studies; Ultrasonography

The aim of the study was to assess changes in plasma natriuretic peptide (NP) levels after spontaneous or electrical cardioversion (CV) in patients with paroxysmal or persistent atrial fibrillation (AF).. Patients with paroxysmal or persistent AF with normal left ventricular function and controlled heart rate, referred for electrical CV, were enrolled prospectively. NP concentrations were measured by means of radioimmunoassay method.. We studied 23 patients with paroxysmal and 77 with persistent AF, spontaneously or electrical cardioverted to sinus rhythm. The mean plasma NP levels were increased in AF patients, ANP: 249±88.3 pg/ml and 258±89.7 pg/ml vs 67±21.2 pg/ml; (p<0.001) and BNP: 99.6±29.8 pg/ml and 82.3±33 pg/ml vs 37.5±13 pg/ml; in the paroxysmal, persistent, and control group, respectively. The mean ANP and BNP levels decreased after sinus restoration from 249.0±88.3 pg/ml to 70.1±13 pg/ml, and from 99.6±29.8 pg/ml to 37.4±8.4 pg/ml, respectively, in the paroxysmal group; from 257.7±89.7 pg/ml to 150.0±87.2 pg/ml and from 82.3±33 pg/ml to 63.7±28.6 pg/ml in the persistent AF group. NP levels remained stable for the next 30 days in the group of patients who remained in sinus rhythm.. Plasma NP concentrations are significantly reduced or normalized after sinus rhythm restoration in patients with paroxysmal and persistent AF and remain stable within 4 weeks of follow-up, provided that AF does not recur.

Topics: Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Case-Control Studies; Electric Countershock; Humans; Natriuretic Peptide, Brain; Natriuretic Peptides; Prognosis; Prospective Studies; Reproducibility of Results; Sensitivity and Specificity; Treatment Outcome

Mutations in multiple genes have been implicated in familial atrial fibrillation (AF), but the underlying mechanisms, and thus implications for therapy, remain ill-defined. Among 231 participants in the Vanderbilt AF Registry, we found a mutation in KCNQ1 (encoding the alpha-subunit of slow delayed rectifier potassium current [I(Ks)]) and separately a mutation in natriuretic peptide precursor A (NPPA) gene (encoding atrial natriuretic peptide, ANP), both segregating with early onset lone AF in different kindreds. The functional effects of these mutations yielded strikingly similar I(Ks) "gain-of-function." In Chinese Hamster Ovary (CHO) cells, coexpression of mutant KCNQ1 with its ancillary subunit KCNE1 generated approximately 3-fold larger currents that activated much faster than wild-type (WT)-I(Ks). Application of the WT NPPA peptide fragment produced similar changes in WT-I(Ks), and these were exaggerated with the mutant NPPA S64R peptide fragment. Anantin, a competitive ANP receptor antagonist, completely inhibited the changes in I(Ks) gating observed with NPPA S64R. Computational simulations identified accelerated transitions into open states as the mechanism for variant I(Ks) gating. Incorporating these I(Ks) changes into computed human atrial action potentials (AP) resulted in 37% shortening (120 vs. 192 ms at 300 ms cycle length), reflecting loss of the phase II dome which is dependent on L-type calcium channel current. We found striking functional similarities due to mutations in KCNQ1 and NPPA genes which led to I(Ks) "gain-of-function", atrial AP shortening, and consequently altered calcium current as a common mechanism between diverse familial AF syndromes.

Topics: Action Potentials; Adult; Atrial Fibrillation; Atrial Natriuretic Factor; Computer Simulation; Electrophysiology; Female; Humans; KCNQ1 Potassium Channel; Male; Middle Aged; Mutation; Phenotype; Polymerase Chain Reaction; Potassium

To evaluate the usefulness of atrial natriuretic peptide (ANP) and brain B-type natriuretic peptide (BNP) for predicting postoperative atrial fibrillation (AF), we determined the changes in perioperative ANP and BNP levels in patients undergoing pulmonary resection for lung cancer.. This prospective observational study was conducted during the 10-month period from July 2007 to April 2008. Eighty patients with lung cancer underwent lobectomy, segmentectomy or wedge resection. Preoperative evaluations included spirometry and examinations of plasma ANP and BNP-levels, which were also determined on postoperative days 1, 3 and 7.. Postoperative AF was identified in 22 (28%) of the patients, and those had significantly higher preoperative ANP and BNP levels as compared with patients without AF. During the postoperative course, patients with postoperative AF also had significantly higher ANP and BNP-levels. The area under the receiver-operating characteristic curve for BNP to predict postoperative AF following pulmonary resection for lung cancer was 0.90 (95% confidence interval (CI), 0.82-0.98; p<0.001). A BNP value of 30pgml(-1) had a sensitivity of 77% and a specificity of 93% for predicting postoperative AF following pulmonary resection for lung cancer.. Preoperative BNP level seems to be an appropriate predictor of AF after pulmonary resection.

Topics: Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Female; Forced Expiratory Volume; Humans; Lung Neoplasms; Male; Middle Aged; Natriuretic Peptide, Brain; Pneumonectomy; Predictive Value of Tests; Prognosis; Prospective Studies; Vital Capacity

A frameshift mutation in the NPPA gene was identified in 1 family with atrial fibrillation (AF), however, further studies are needed to establish unequivocally the genetic association between NPPA and AF.. A case control association study and mutational analysis of NPPA were performed with 384 sporadic AF patients and 844 controls from a Chinese GeneID population. Genotyping was performed using High-Resolution Melt analysis. Mutational analysis was performed using direct DNA sequencing analysis.. Significant allelic association was detected between single nucleotide polymorphism (SNP) rs5063 and lone AF (p=0.015, OR=1.63; adjusted p=0.003). Genotypic association was significant assuming an additive or dominant model (adjusted p=0.005 and 0.007, respectively). Six new variants were identified in NPPA, including 2 in the 5'-UTR, 2 in the 3'-UTR, and 2 missense substitutions. Variants c.413T>C, c.*48G>A and c.*133G>T were not present in 844 controls, and the others were identified in controls.. Variants in NPPA confer risk of lone AF in a Chinese population. Thus, in addition to being a disease-causing gene with mutations identified in familial AF cases, NPPA is a susceptibility gene for lone AF.

Topics: Alleles; Asian People; Atrial Fibrillation; Atrial Natriuretic Factor; China; Female; Genetic Variation; Humans; Male; Middle Aged; Mutation; Polymorphism, Single Nucleotide

Topics: Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Electric Countershock; Heart Atria; Humans; Prognosis; Ultrasonography

The effects of ganglionated plexi (GP) ablation on atrial fibrillation (AF) inducibility and atrial autonomic innervation remodelling have not been elucidated.. Thirteen dogs were randomly divided into sham-operated group and GP ablation group. All animals underwent a right thoracotomy at the fourth intercostal space. Atrial fibrillation inducibility was assessed by burst rapid pacing at right atrium (RA). After anterior right GP and inferior right GP ablation, AF inducibility was assessed in the GP ablation group. The animals were allowed to recover for 8 weeks, after which, AF was measured again. The levels of atrial natriuretic peptide (ANP) in blood and atrial tissues were examined by radioimmunoassay. Immunocytochemical staining of cardiac nerves was performed in tissues from the dogs. Atrial fibrillation was induced easily in the GP ablation group after 8 weeks although AF was not observed in the sham-operated group, and after instant GP ablation. Compared with that in the sham-operated group, the levels of ANP in the blood and RA increased significantly 8 weeks after GP ablation (111.4 +/- 18.2 vs. 175.1 +/- 25.9; 184.9 +/- 36.3 vs. 299.1 +/- 32.5; P < 0.05). In the GP ablation group, the density of growth-associated protein 43-positive, tyrosine hydroxylase-positive, and choline acetyltransferase-positive nerves in the RA was 821 +/- 752, 481 +/- 627, and 629 +/- 644 per mm(2), respectively, which was significantly (P < 0.01) lower than the nerve density in sham-operated tissues (2590 +/- 841, 1752 +/- 605, and 3147 +/- 886 per mm(2), respectively).. Atrial autonomic innervations remodelling may be the mechanism of induced AF after GP ablation.

Topics: Animals; Atrial Fibrillation; Atrial Natriuretic Factor; Autonomic Pathways; Cardiac Pacing, Artificial; Cardiac Volume; Catheter Ablation; Cholinergic Fibers; Denervation; Disease Models, Animal; Dogs; Electrocardiography; Female; Ganglia, Autonomic; GAP-43 Protein; Heart; Heart Atria; Immunohistochemistry; Male; Radioimmunoassay; Recurrence

Natriuretic peptides (NPs) are excellent diagnostic and prognostic markers of heart failure, but their roles in atrial fibrillation (AF), particularly of isolated cardiac valvular origin, are unclear. We assessed the mRNA and protein content of pro-atrial natriuretic peptide (pro-ANP) and pro-brain natriuretic peptide (pro-BNP) in right atrial appendages (RAAs) and their N-terminal fragments (nt-proANP and nt-proBNP) in the plasma of 30 patients with paroxysmal AF (PaAF) and 40 patients with persistent AF (PeAF) matched with 34 patients in sinus rhythm (SR) undergoing isolated valvular replacement. To explore the underlying mechanism, fibrosis related examinations were simultaneously carried out in RAAs. Unexpectedly, atrial expression of pro-NPs mRNA was notably augmented in the PaAF subgroup, but not so pronounced in the PeAF subgroup. Atrial content of pro-NPs proteins and plasma nt-proNPs, between which surprisingly strong positive correlations were found (pro-ANP and nt-proANP: r=0.918, p<0.001; pro-BNP and nt-proBNP: r=0.913, p<0.001), were increased analogously in PaAF and PeAF subgroups. We identified significantly increasing gradients of atrial collagen volume fraction (CVF), levels of collagen I and III in the SR, PaAF and PeAF groups, and convincing negative linear correlations between CVF, levels of collagen I and III, and atrial transcripts of pro-NPs. These findings suggest that the discordance between transcripts and protein contents of pro-NPs was possibly due to the more outstanding atrial fibrosis in PeAF, and that circulating nt-proNPs levels could reflect the corresponding atrial pro-NPs contents in this report.

Topics: Adult; Atrial Appendage; Atrial Fibrillation; Atrial Function, Right; Atrial Natriuretic Factor; Collagen Type I; Collagen Type III; Female; Fibrosis; Gene Expression Regulation; Humans; Male; Middle Aged; Myocardium; Natriuretic Peptide, Brain; Natriuretic Peptides; Peptide Fragments; Protein Precursors; RNA, Messenger; Tachycardia, Paroxysmal

Measurement of natriuretic peptide's (NP) release in response to hemodynamic stress may be complementary to its baseline assessment in individuals. Atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) increase in patients with atrial fibrillation (AF) and decrease after successful cardioversion, suggesting that AF may stimulate secretion of NPs. However, there are conflicting data on the predictive value of NPs on the cardioversion outcome.. The purpose of this study was to investigate whether baseline and exercise-induced NP plasma levels can be useful in predicting successful cardioversion of persistent AF and maintenance of sinus rhythm during 6-month follow-up.. A prospective study enrolled 77 consecutive subjects with persistent AF with normal left ventricular function, referred for elective cardioversion. Patients underwent a modified Bruce protocol treadmill exercise test 24 hours before cardioversion. Blood samples for ANP and BNP analyses were obtained at rest and 5 minutes after exercise peak.. The group of successful cardioversion and stable sinus rhythm presented higher exercise ANP (110.6 ± 41.2 pg/mL vs 43.8 ± 36.1; pg/mL, P < 0.0001) and lower BNP increase (5.2 ± 5.2 pg/mL vs 40.5 ± 34.2 pg/mL, P < 0.0001) than the group of unsuccessful cardioversion or AF recurrence. Using an optimized cutoff level of ≤12% of relative exercise-induced increase in BNP concentration, and of >50 pg/mL of ANP increase, successful cardioversion can be predicted with high accuracy.. An increase in ANP and stability of BNP plasma concentration during exercise testing are independently associated with successful cardioversion and maintenance of sinus rhythm during 6-month follow-up. (PACE 2010; 33:1203-1209).

Topics: Adult; Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Chronic Disease; Coronary Sinus; Electric Countershock; Exercise Test; Humans; Middle Aged; Natriuretic Peptide, Brain; Prognosis; Prospective Studies; Treatment Outcome

Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, is an important cause of morbidity and mortality. A genetic mutation in the NPPA gene, which encodes the atrial natriuretic peptide, has been identified as the putative causative factor in a family with an autosomal dominant pattern of inheritance for AF. Two common single nucleotide polymorphisms (SNPs) in NPPA, rs5063 and rs5065, result in amino acid changes of the primary peptide and have been previously implicated in conditions associated with AF, including stroke and hypertension. Recently, the rs5063 SNP has been reported to confer an increased risk of AF development in a Chinese population. We sought to examine the associations of both rs5063 and rs5065 with AF in two separate North American cohorts of European ancestry.. Patients with early-onset AF, along with healthy controls, were recruited at the University of Ottawa Heart Institute (UOHI) and the Massachusetts General Hospital (MGH). Study participants were genotyped for rs5063 and rs5065 using a combination of restriction fragment length polymorphism analysis and DNA microarrays. The study genotyped a total of 620 AF cases and 2446 healthy controls. The UOHI arm of the study identified an odds ratio (OR) of 0.72 [95% confidence interval (CI): 0.42-1.24] for rs5063, whereas an OR of 1.33 (95% CI: 0.80-2.21) was observed in the MGH arm. The combined OR approximated unity (OR 0.99; 95% CI: 0.54-1.80). Analysis of rs5065 revealed an OR of 1.12 (95% CI: 0.84-1.48) in UOHI, 1.08 (95% CI 0.80-1.45) in MGH, and 1.10 (95% CI 0.90-1.35) when combined.. Common non-synonymous genetic variants within NPPA in these two large North American cohorts of European ancestry are not associated with the development of AF.

Topics: Adult; Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Case-Control Studies; Female; Genetic Predisposition to Disease; Genotype; Humans; Male; Middle Aged; North America; Polymorphism, Single Nucleotide; Protein Processing, Post-Translational; White People

Renin-angiotensin system may be activated during atrial fibrillation (AF). Our aim was to evaluate plasma renin activity (PRA) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in patients with different AF types who had normal left ventricular (LV) systolic function.. This cross-sectional study included 97 patients with recent (or=1.9 ng/ml/hour (OR=1.1, 95% CI 1.01-1.23, p=0.03). With NT-proBNP level >or=52 pg/ml, independent predictors were age (OR=1.1, 95% CI 1.01-1.19, p=0.02), presence of persistent and/or permanent AF (OR=6.8, 95% CI 1.03-45.7, p=0.04) and left atrial dimension (OR=1.2, 95% CI 1.03-1.36, p=0.02).. Plasma NT-proBNP levels can be associated with AF and its subtypes in patients with normal LV systolic function, whereas there was no association between PRA levels and AF.

Topics: Atrial Fibrillation; Atrial Natriuretic Factor; Cross-Sectional Studies; Echocardiography; Female; Humans; Male; Natriuretic Peptide, Brain; Patient Selection; Peptide Fragments; Reference Values; Renin

The human heart can be frequently affected by an organ-limited amyloidosis called isolated atrial amyloidosis (IAA). IAA is a frequent histopathological finding in patients with long-standing atrial fibrillation (AF). The aim of this paper was to investigate the ultrastructure of cardiomyocytes and telocytes in patients with AF and IAA. Human atrial biopsies were obtained from 37 patients undergoing cardiac surgery, 23 having AF (62%). Small fragments were harvested from the left and right atrial appendages and from the atrial sleeves of pulmonary veins and processed for electron microscopy (EM). Additional fragments were paraffin embedded for Congo-red staining. The EM examination certified that 17 patients had IAA and 82% of them had AF. EM showed that amyloid deposits, composed of characteristic 10-nm-thick filaments were strictly extra-cellular. Although, under light microscope some amyloid deposits seemed to be located within the cardiomyocyte cytoplasm, EM showed that these deposits are actually located in interstitial recesses. Moreover, EM revealed that telopodes, the long and slender processes of telocytes, usually surround the amyloid deposits limiting their spreading into the interstitium. Our results come to endorse the presumptive association of AF and IAA, and show the exclusive, extracellular localization of amyloid fibrils. The particular connection of telopodes with amyloid deposits suggests their involvement in isolated atrial amyloidosis and AF pathogenesis.

Topics: Adult; Aged; Amyloid; Amyloidosis; Atrial Appendage; Atrial Fibrillation; Atrial Natriuretic Factor; Cardiomyopathies; Cells, Cultured; Female; Heart Atria; Humans; Interstitial Cells of Cajal; Male; Microscopy, Electron; Middle Aged; Myocytes, Cardiac; Plaque, Amyloid; Stromal Cells

the purpose of this study was to assess the predictive accuracy of conventional cardiovascular risk factors for incident heart failure and atrial fibrillation, and the added benefit of multiple biomarkers reflecting diverse pathophysiological pathways.. heart failure and atrial fibrillation are interrelated cardiac diseases associated with substantial morbidity and mortality and increasing incidence. Data on prediction and prevention of these diseases in healthy individuals are limited.. in 5,187 individuals from the community-based MDCS (Malmö Diet and Cancer Study), we studied the performance of conventional risk factors and 6 biomarkers including midregional pro-atrial natriuretic peptide (MR-proANP), N-terminal pro-B-type natriuretic peptide (NT-proBNP), midregional pro-adrenomedullin, cystatin C, C-reactive protein (CRP), and copeptin.. during a mean follow-up of 14 years, 112 individuals were diagnosed with heart failure and 284 individuals with atrial fibrillation. NT-proBNP (hazard ratio [HR]: 1.63 per SD, 95% confidence interval [CI]: 1.29 to 2.06, p < 0.001), CRP (HR: 1.57 per SD, 95% CI: 1.28 to 1.94, p < 0.001), and MR-proANP (HR: 1.26 per SD, 95% CI: 1.02 to 1.56, p = 0.03) predicted incident heart failure independently of conventional risk factors and other biomarkers. MR-proANP (HR: 1.62, 95% CI: 1.42 to 1.84, p < 0.001) and CRP (HR: 1.18, 95% CI: 1.03 to 1.34, p = 0.01) independently predicted atrial fibrillation. Addition of biomarkers to conventional risk factors improved c-statistics from 0.815 to 0.842 for heart failure and from 0.732 to 0.753 for atrial fibrillation and the integrated discrimination improvement for both diseases (p < 0.001). Net reclassification improvement (NRI) with biomarkers was observed in 22% of individuals for heart failure (NRI, p < 0.001) and in 7% for atrial fibrillation (NRI, p = 0.06), mainly due to up-classification of individuals who developed disease (heart failure: 29%, atrial fibrillation: 19%). Addition of CRP to natriuretic peptides did not improve discrimination or reclassification.. conventional cardiovascular risk factors predict incident heart failure and atrial fibrillation with reasonable accuracy in middle-age individuals free from disease. Natriuretic peptides, but not other biomarkers, improve discrimination modestly for both diseases above and beyond conventional risk factors and substantially improve risk classification for heart failure.

Topics: Aged; Aged, 80 and over; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; C-Reactive Protein; Confidence Intervals; Female; Follow-Up Studies; Heart Failure; Humans; Incidence; Male; Middle Aged; Natriuretic Peptide, Brain; Odds Ratio; Peptide Fragments; Prognosis; Prospective Studies; Protein Precursors; Risk Assessment; Risk Factors; ROC Curve; Sweden; Time Factors

Risk stratification for cardiovascular outcomes is gaining importance in general population. Prognostic value of natriuretic peptides has been established in patients with heart failure. However, the prognostic significance of natriuretic peptides with respect to stroke is not well known in general populations.. Plasma natriuretic peptides were measured in a representative population-based sample of 958 men (age 46-65 years) from Eastern Finland. There were 46 cases of stroke, 74 of atrial fibrillation and 31 cases of ischaemic strokes during a follow-up of 9.6 years.. The multivariable adjusted risk was 1.35-fold (95% CI 1.01 to 1.84, p = 0.049) for any stroke and 1.30-fold (95% CI 0.90 to 1.91, p = 0.0150) for ischaemic stroke for each log-transformed SD (0.240 pmol/l) increment in N-terminal fragment of proA-type natriuretic peptide. The respective risks were 1.36-fold (95% CI 1.05 to 1.76, p = 0.010) and 1.50-fold (95% CI 1.12 to 2.02, p = 0.007) for each log-transformed SD (0.237 pmol/l) increment in N-terminal fragment of proB-type natriuretic peptide. The multivariate adjusted risks for future atrial fibrillation were 1.71 (95% CI 1.32 to 2.22, p<0.001) and 1.68-fold (95% CI 1.38 to 2.07, p<0.001) for each log-transformed SD increment in N-terminal fragments of proA- and proB-type natriuretic peptides, respectively.. N-terminal fragments of pro-atrial natriuretic peptide and pro-brain natriuretic peptide are new additional predictors of any stroke and atrial fibrillation. Natriuretic peptides provide prognostic information for stroke and atrial fibrillation and may help in identifying subjects at risk for stroke and atrial fibrillation.

Topics: Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Follow-Up Studies; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Natriuretic Peptides; Peptide Fragments; Prognosis; Protein Precursors; Risk Assessment; Stroke

Assessment of endocrine profile in patients with cardiovascular diseases has become increasingly important during the last decade. Plasma brain natriuretic peptide (BNP) levels have been used as a marker of left ventricular dysfunction. However, the role of BNP in patients with atrial fibrillation (AF) and normal left ventricular function has not yet been determined.. To examine changes in the secretion of natriuretic peptides (atrial natriuretic peptide - ANP and BNP) during exercise in patients with persistent or permanent AF.. The study group consisted of 42 patients with permanent AF and 77 patients with persistent AF. There were no significant differences in baseline clinical (except AF duration), echocardiographic and haemodynamic data between the groups. The control group comprised 20 patients. All had normal sinus rhytm without a history of AF and were compatible in age, gender and concomitant diseases with the examined groups. The ANP and BNP samples were obtained at rest and at the peak of the exercise testing. Duration of exercise testing was 10 min.. The multiple regression analysis showed an association between ANP levels and left atrial volume (p = 0.0001), maximal heart rate (p = 0.0036) and NYHA class (p < 0.0001). There was a trend toward a significant relation between AF duration and ANP levels. There was a significant correlation between BNP levels and heart failure class according to NYHA (p < 0.0001). A significant and strong positive correlation of ANP and BNP concentrations at rest was observed in all groups of AF. Significant variation of natriuretic peptide release in response to exercise (ANPex and BNPex) was observed. The highest increase of ANP level and the lowest increase of BNP level were noted in the control group, and no significant differences were found in ANP and BNP secretion between the groups with persistent and permanent AF.. Neurohormonal response to exercise differs between patients with AF and those in sinus rhythm. Exercise testing may be used to assess the ability of cardiac myocytes to increase peptide secretion.

Topics: Adult; Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Exercise; Exercise Test; Female; Heart Rate; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Oxygen Consumption; Physical Endurance; Poland; Predictive Value of Tests; Regression Analysis

Topics: Adult; Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Exercise; Exercise Test; Female; Heart Rate; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Oxygen Consumption; Physical Endurance; Poland; Predictive Value of Tests; Regression Analysis

Diastolic heart failure often coexists with atrial fibrillation (AF). Elevated plasma levels of natriuretic peptides are the left ventricular (LV) marker of diastolic dysfunction.. To evaluate the influence of sinus rhythm restoration on ANP and BNP levels in patients with normal and impaired LV diastolic function.. The study included 42 patients (19 men, 23 women), aged 58.6 +/- 8.2 years with non-valvular persistent AF with preserved LV systolic function who were successfully converted to sinus rhythm by DC cardioversion (CV) and maintained sinus rhythm for at least 30 days. On day 30 following CV in patients with sinus rhythm, Doppler echocardiography was performed to assess LV diastolic function. ECG, echocardiography, ANP and BNP plasma level measurements were made at baseline 24 h before CV and 24 h as well as 30 days after CV.. The average ANP level in the whole study group during AF was 254.9 +/- 79.9 pg/ml and the average BNP level was 113.6 +/- 49.1 pg/ml. There was an evident decrease in ANP/BNP serum concentration in all the patients after successful DC cardioversion. Measured on the 30th day after CV, ANP and BNP levels were 153.2 +/- 67.9 pg/ml and 61.9 +/- 25.1 pg/ml respectively (p < 0.001). Thirty days after CV normal LV diastolic function was diagnosed in 15 patients and in 27 patients impaired diastolic function: 20 with impaired LV relaxation and 7 with impaired LV compliance. The extent of natriuretic peptides drop was dependent on the LV diastolic function, being more substantial in the subgroup with impaired LV diastolic function. In the subgroup with LV diastolic dysfunction the average ANP serum concentration measured 30 days after conversion was reduced by 111.2 +/- 93.9 pg/ml (37%) (p < 0.001) and BNP level was reduced by 67.5 +/- 36.0 pg/ml (46%) (p < 0.001). In patients with normal diastolic function sinus rhythm restoration significantly influenced ANP level, while having no relevant effect on BNP plasma concentration. The average ANP reduction in this subgroup was 64.4 +/- 71.8 pg/ml (by 38%) and BNP reduction was 11.4 +/- 16.7 pg/ml (by 23%) (NS).. The drop in ANP and BNP plasma concentrations after conversion to sinus rhythm in patients with AF depends on the LV diastolic function. Restoration of sinus rhythm is associated with improvement of the heart's haemodynamics, especially in patients with impaired LV diastolic function, which may be inferred from the more pronounced decrease of BNP level after DC cardioversion in this subgroup, as compared to that with normal LV function.

Topics: Adult; Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Electric Countershock; Female; Heart Failure, Diastolic; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Ultrasonography; Ventricular Dysfunction, Left

The diagnosis of the impaired left ventricle (LV) diastolic function during atrial fibrillation (AF) using traditional methods is very difficult. Natriuretic peptides seem to be useful for assessment of diastolic function in patients with AF.. To evaluate the influence of LV diastolic dysfunction on natriuretic peptides concentrations and to assess the diagnostic value of atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) in patients with AF and impaired LV diastolic function.. The study included 42 patients (23 males, 19 females), aged 58.6 +/- 8.2 years with nonvalvular persistent AF with preserved LV systolic function who were converted into sinus rhythm by DC cardioversion (CV) and maintained sinus rhythm for at least 30 days. Echocardiography (ECG), ANP, and BNP level measurements were taken at baseline 24 hours before CV and 24 hours and 30 days after CV. On the 30th day following CV in patients with sinus rhythm, Doppler ECG was performed to assess LV diastolic function.. Thirty days after CV, normal LV diastolic function in 15 patients and impaired diastolic function in 27 patients was diagnosed: 20 with impaired LV relaxation and seven with impaired LV compliance. During AF and 24 hours, and 30 days after sinus rhythm restoration, significantly higher ANP and BNP levels were observed in patients with LV diastolic dysfunction as compared to the subgroup with normal LV diastolic function. The average values of ANP during AF in patients with normal and impaired diastolic function were 167.3 +/- 70.1 pg/mL and 298.7 +/- 83.6 pg/mL, respectively (P < 0.001), and the average values of BNP in the above mentioned subgroups were 49.5 +/- 14.7 pg/mL and 145.6 +/- 49.6 pg/mL respectively (P < 0.001). While comparing the diagnostic value of both natriuretic peptides it was noted that BNP was a more specific and sensitive marker of impaired LV diastolic function. ANP value >220.7 pg/mL measured during AF identified patients with impaired LV diastolic function with 85% sensitivity and 90% specificity. BNP value >74.7 pg/mL proved 95% sensitive and 100% specific in the diagnosing of such a group.. The increase of ANP/BNP concentration in patients with AF results not only from the presence of AF, but also reflects the impaired LV diastolic function. Natriuretic peptides, especially BNP, may be useful in diagnosing LV diastolic dysfunction in patients with AF.

Topics: Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Reproducibility of Results; Sensitivity and Specificity; Ventricular Dysfunction, Left

Topics: Amyloidosis; Atrial Fibrillation; Atrial Natriuretic Factor; Heart Atria; Humans; Inflammation; Time Factors

Atrial fibrillation is a common arrhythmia that is hereditary in a small subgroup of patients. In a family with 11 clinically affected members, we mapped an atrial fibrillation locus to chromosome 1p36-p35 and identified a heterozygous frameshift mutation in the gene encoding atrial natriuretic peptide. Circulating chimeric atrial natriuretic peptide (ANP) was detected in high concentration in subjects with the mutation, and shortened atrial action potentials were seen in an isolated heart model, creating a possible substrate for atrial fibrillation. This report implicates perturbation of the atrial natriuretic peptide-cyclic guanosine monophosphate (cGMP) pathway in cardiac electrical instability.

Topics: Action Potentials; Adult; Animals; Atrial Fibrillation; Atrial Natriuretic Factor; Chromosome Mapping; Chromosomes, Human, Pair 1; DNA Mutational Analysis; Female; Frameshift Mutation; Guanosine Monophosphate; Humans; Male; Middle Aged; Pedigree; Signal Transduction; White People

Topics: Atrial Fibrillation; Atrial Natriuretic Factor; Catheter Ablation; Echocardiography, Doppler; Heart Failure; Humans; Natriuretic Peptide, Brain

Sotalol is a class III antiarrhythmic agent that is highly effective for tachyarrhythmias in adults, but its efficacy in patients with congenital heart disease (CHD) remains unclear. The purpose of this study was to assess the efficacy and safety of sotalol for refractory tachyarrhythmias in patients with CHD.. Forty four-patients with CHD and refractory tachyarrhythmias (age, 23+/-12 years; follow-up period, 13+/-12 months) were administered sotalol orally during the period December 2002 to May 2007, resulting in complete control of tachyarrhythmias in 18 patients (41%), partial control in 15 patients (34%), and no control in 11 patients (25%). Non-pharmacological intervention (eg, surgery, pacemaker implantation, catheter ablation) was performed in 9 patients and resulted in an augmented response to sotalol in 6 patients. Tachyarrhythmia combined with atrial fibrillation was a risk factor for treatment failure with sotalol (odds ratio, 18.3; 95% confidence interval, 1.8-189.6; p=0.0053).. Sotalol is partially or completely effective for refractory tachyarrhythmias in patients with CHD, and non-pharmacological interventions improve the efficacy of sotalol. This multimodal approach should be considered in patients with refractory tachyarrhythmias and CHD.

Topics: Administration, Oral; Adolescent; Adult; Anti-Arrhythmia Agents; Atrial Fibrillation; Atrial Natriuretic Factor; Cardiac Pacing, Artificial; Cardiac Surgical Procedures; Catheter Ablation; Child; Child, Preschool; Combined Modality Therapy; Electrocardiography; Female; Heart Defects, Congenital; Heart Rate; Humans; Infant; Male; Natriuretic Peptide, Brain; Odds Ratio; Retrospective Studies; Risk Assessment; Risk Factors; Sotalol; Tachycardia; Time Factors; Treatment Failure; Young Adult

The aim of the study was to evaluate plasma natriuretic peptides (NPs): atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) concentrations in patients with paroxysmal, persistent and permanent atrial fibrillation (AF).. The study groups consisted of 23 patients with paroxysmal AF, 42 patients with permanent AF and 77 patients with persistent AF with normal left ventricular function. The mean ANP level was increased in AF patients in the paroxysmal, persistent and permanent groups: 249 +/- 88.3 pg/mL; 258 +/- 89.7 pg/mL; 208 +/- 76.7 pg/mL, respectively, vs. 67 +/- 21.2 pg/mL in the control subjects (p < 0.001). The mean BNP level was increased in AF patients in the paroxysmal, persistent and permanent groups: 99.6 +/- 29.8 pg/mL; 82.3 +/- 33 pg/mL; 95.6 +/- 46.4 pg/mL, respectively, vs. 37.5 +/- 13 pg/mL in the control group. Multivariate logistic regression analysis revealed a positive correlation between ANP levels, maximal left atrial volume, heart rate and New York Heart Association (NYHA) classification, in the persistent AF patients. A positive correlation between plasma BNP levels and heart failure stage according to NYHA classification in this group was found. Baseline ANP concentrations were positively correlated with baseline BNP concentrations in AF patients.. Plasma NPs levels are increased in patients with paroxysmal, persistent and permanent AF and normal left ventricle function, and positively correlated with left atrial volume, heart rate and heart failure stage according to NYHA classification. Neurohormonal assessment does not distinguish the type of arrhythmia.

Topics: Adult; Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Disease Progression; Electrocardiography, Ambulatory; Female; Follow-Up Studies; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Natriuretic Peptides; Prognosis; Prospective Studies; Radioimmunoassay; Stroke Volume

To compare peripheral blood hematopoietic progenitor cells (HPCs), plasma atrial natriuretic peptide (ANP) and stromal cell-derived factor-1alpha (SDF-1alpha) among patients with paroxysmal, permanent atrial fibrillation (AF) or sinus rhythm.. Peripheral blood concentration of CD34+HPCs were quantified by flow cytometric analysis (FCM), plasma ANP levels were measured by radioimmunoassay (RIA) method, plasma levels of SDF-1alpha were determined by enzyme linked immunosorbent assay (ELISA) in 30 patients with permanent AF, 28 patients with paroxysmal AF, and 30 patients with sinus rhythm (SR). HPCs were separated, cultured and stained for ANP by the use of alkaline phosphatase-anti-alkaline phosphatase technique (APAAP) in 30 patients (10 from each group).. (1) The number of CD34+HPCs in permanent AF group [(5.31 +/- 1.67) x 10(6)/L] were significantly higher comparing to paroxysmal AF group [(2.33 +/- 1.29) x 10(6)/L] (P < 0.05) and SR group [(2.03 +/- 0.64) x 10(6)/L] (P < 0.05) while CD34+HPCs was similar between paroxysmal AF group and SR group (P > 0.05). (2) Plasma levels of ANP (0.312 +/- 0.121) microg/L and SDF-1alpha (3210.2 +/- 1234.7) ng/L were also significantly higher in permanent AF group than paroxysmal AF group and SR group (all P < 0.05) and were similar in paroxysmal AF group and SR group (all P > 0.05). (3) The plasma levels of ANP and SDF-1alpha were both positive correlated with peripheral blood concentration of CD34+HPCs (r = 0.783, P < 0.01; r = 0.427, P < 0.01). (4) After 3 days of culture, ANP was weakly expressed in HPCs from patients with permanent AF but not from patients with paroxysmal AF and SR.. Peripheral blood HPCs together with plasma ANP and SDF-1alpha were significantly increased in patients with permanent AF. CD34+HPCs were positive correlated with the plasma levels of ANP and SDF-1alpha.

Topics: Adult; Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Chemokine CXCL12; Female; Hematopoietic Stem Cells; Humans; Male; Middle Aged

The role of atrial (ANP) and B-type (BNP) natriuretic peptide in atrial fibrillation (AF) is not clear. Our aim was to describe ANP and BNP in AF, and their changes following cardioversion in persistent AF. Furthermore, we wanted to assess the association between ANP and BNP and cardiac volume and function evaluated by magnetic resonance imaging. ANP and BNP decreased significantly following cardioversion. After 180 days of sinus rhythm, ANP and BNP were still significantly elevated. Same results were seen in patients with lone AF. Left and right atrial volumes correlated positively with ANP and BNP. Changes in left atrial volume were predictive of changes in ANP and BNP following cardioversion. AF may cause enduringly elevated ANP and BNP and atrial volume seems to be an important determinant of ANP and BNP in AF.

Topics: Atrial Fibrillation; Atrial Function; Atrial Natriuretic Factor; Cardiac Volume; Electric Countershock; Humans; Natriuretic Peptide, Brain; Time Factors; Ventricular Function

Our objective was to assess the effect of omega-3 polyunsaturated fatty acids (n-3 PUFAs) on atrial fibrillation (AF) vulnerability and atrial structure in a new model of atrial cardiomyopathy.. Dogs were studied in three groups: seven control dogs (UNPACED) and 24 dogs undergoing simultaneous atrioventricular pacing (for 2 weeks) assigned to placebo treatment (SAVP-PLACEBO, n = 12 dogs) or oral n-3 PUFAs (1 g/day) treatment (SAVP-PUFA, n = 12 dogs). SAVP-PUFA dogs had less AF inducibility (percentage of burst attempts leading to AF episodes: 5.5 +/- 7.4 vs. 20.4 +/- 14.2, P < 0.001) and maintenance [median AF duration: 601 s (377-1216) vs. 1598 s (1195-2400), P < 0.05] than SAVP-PLACEBO dogs. SAVP-PUFA dogs had significantly less local slowing of conduction and conduction heterogeneity than SAVP-PLACEBO dogs. SAVP-PUFA dogs had a significantly smaller increase in atrial matrix metalloproteinase-9 activity and in collagen type I and III messenger RNA expression (in arbitrary units) than SAVP-PLACEBO dogs (0.62 +/- 0.51 vs. 10.80 +/- 5.61, respectively for collagen I, P < 0.05; 1.66 +/- 0.48 vs. 5.24 +/- 1.16, respectively, for collagen III, P < 0.05).. n-3 PUFA supplementation can reduce AF vulnerability in a new canine pacing model of atrial cardiomyopathy. The mechanism may be related to attenuation of collagen turnover.

Topics: Animals; Atrial Fibrillation; Atrial Natriuretic Factor; Cardiac Pacing, Artificial; Dogs; Echocardiography; Fatty Acids, Omega-3; Female; Heart; Male; Matrix Metalloproteinase 9; Models, Animal; Myocardium; Transforming Growth Factor beta1

Assess the impact of persistent/permanent atrial fibrillation (AF) ablation on endocrine and mechanical cardiac functions.. In all, 43 patients (40 males, 53 +/- 12 years) undergoing persistent/permanent AF ablation had atrial (ANP) and brain natriuretic peptide (BNP) measurements before day 1, 3, and 3 months after ablation. In the same period of time transthoracic echocardiography was performed. With a mean radiofrequency delivery of 98 +/- 29 min, sinus rhythm (SR) was restored in 30 patients (70%) without DC shock. ANP decreased significantly (P < 0.001) with restoration of SR and then increased until day 3 post ablation without reaching the level observed during AF. At 3 months, ANP was significantly lower than day 3 reaching normal value in 28 (65%) patients and being <7 pg/mL in 4 (9%). The BNP followed the same trend with normal BNP level in 23 (53%) patients at 3 months. Identifiable atrial filling waves on the pulsed Doppler transmitral recordings performed between day 2 and day 4 after the procedure were seen in 18 patients (42%). At 3 months, 39 (95%) of the patients with SR during echocardiography had a significant A wave.. SR following persistent/permanent AF ablation is associated with a dramatic decrease in natriuretic peptides. At 3 months, despite relatively extensive atrial ablation, endocrine and mechanical cardiac functions are significantly improved.

Topics: Atrial Fibrillation; Atrial Function; Atrial Natriuretic Factor; Catheter Ablation; Echocardiography, Doppler; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Troponin I

Endothelial dysfunction is present in patients with heart failure (HF) due to left ventricular systolic dysfunction, as well as in patients with atrial fibrillation (AF) who have normal cardiac function. It is unknown whether AF influences the degree of endothelial dysfunction in patients with systolic HF.. We measured levels of plasma von Willebrand factor (vWF) and E-selectin (as indexes of endothelial damage/dysfunction and endothelial activation, respectively; both enzyme-linked immunosorbent assay) in patients with AF and HF (AF-HF), who were compared to patients with sinus rhythm and HF (SR-HF), as well as in age-matched, healthy, control subjects. We also assessed the relationship of vWF and E-selectin to plasma N-terminal pro B-type natriuretic peptide (NTpro-BNP), a marker for HF severity and prognosis.. One hundred ninety patients (73% men; mean age, 69.0 +/- 10.1 years [+/- SD]) with systolic HF were studied, who were compared to 117 healthy control subjects: 52 subjects (27%) were in AF, while 138 subjects (73%) were in sinus rhythm. AF-HF patients were older than SR-HF patients (p = 0.046), but left ventricular ejection fraction and New York Heart Association class were similar. There were significant differences in NT-proBNP (p < 0.0001) and plasma vWF (p = 0.003) between patients and control subjects. On Tukey post hoc analysis, AF-HF patients had significantly increased NT-proBNP (p < 0.001) and vWF (p = 0.0183) but not E-selectin (p = 0.071) levels when compared to SR-HF patients. On multivariate analysis, the presence of AF was related to plasma vWF levels (p = 0.018). Plasma vWF was also significantly correlated with NT-proBNP levels (Spearman r = 0.139; p = 0.017).. There is evidence of greater endothelial damage/dysfunction in AF-HF patients when compared to SR-HF patients. The clinical significance of this is unclear but may have prognostic value.

Topics: Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; E-Selectin; Electrocardiography; Endothelium, Vascular; Enzyme-Linked Immunosorbent Assay; Female; Follow-Up Studies; Heart Failure, Systolic; Heart Rate; Humans; Male; Prognosis; Prospective Studies; Protein Precursors; Severity of Illness Index; Stroke Volume; Ventricular Function, Left; von Willebrand Factor

Topics: Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Female; Heart Failure; Humans; Male; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prognosis; Protein Precursors; Randomized Controlled Trials as Topic

Atrial fibrillation (AF) is the most frequent arrhythmia found in clinical practice. In recent studies, a decrease in the development or recurrence of AF was found in hypertensive patients treated with angiotensin-converting enzyme inhibitors or angiotensin receptor-blocking agents. Hypertension is related to an increased wall tension in the atria, resulting in increased stretch of the individual myocyte, which is one of the major stimuli for the remodeling process. In the present study, we used a model of cultured atrial neonatal rat cardiomyocytes under conditions of stretch to provide insight into the mechanisms of the preventive effect of the angiotensin receptor-blocking agent losartan against AF on a molecular level. Stretch significantly increased protein-to-DNA ratio and atrial natriuretic factor mRNA expression, indicating hypertrophy. Expression of genes encoding for the inward rectifier K(+) current (I(K1)), Kir 2.1, and Kir 2.3, as well as the gene encoding for the ultrarapid delayed rectifier K(+) current (I(Kur)), Kv 1.5, was significantly increased. In contrast, mRNA expression of Kv 4.2 was significantly reduced in stretched myocytes. Alterations of gene expression correlated with the corresponding current densities: I(K1) and I(Kur) densities were significantly increased in stretched myocytes, whereas transient outward K(+) current (I(to)) density was reduced. These alterations resulted in a significant abbreviation of the action potential duration. Losartan (1 microM) prevented stretch-induced increases in the protein-to-DNA ratio and atrial natriuretic peptide mRNA expression in stretched myocytes. Concomitantly, losartan attenuated stretch-induced alterations in I(K1), I(Kur), and I(to) density and gene expression. This prevented the stretch-induced abbreviation of action potential duration. Prevention of stretch-induced electrical remodeling might contribute to the clinical effects of losartan against AF.

Topics: Action Potentials; Angiotensin II Type 1 Receptor Blockers; Animals; Animals, Newborn; Antihypertensive Agents; Atrial Fibrillation; Atrial Natriuretic Factor; Cell Enlargement; Cell Shape; Cell Size; Cells, Cultured; Gene Expression; Heart Atria; Hypertension; Kinetics; Kv1.5 Potassium Channel; Losartan; Mechanotransduction, Cellular; Myocytes, Cardiac; Potassium; Potassium Channels, Inwardly Rectifying; Potassium Channels, Voltage-Gated; Rats; RNA, Messenger; Shal Potassium Channels

Postoperative atrial fibrillation (AF) is a complication of thoracic surgery for lung cancer, with a reported incidence that can run as high as 42%. Recently, it has been observed retrospectively that B-type natriuretic peptide predicts AF after cardiac surgery. We performed a prospective study to evaluate the role of N-terminal pro-B-type natriuretic peptide (NT-proBNP) as a marker for risk stratification of postoperative AF in patients undergoing thoracic surgery for lung cancer.. We measured NT-proBNP levels in 400 patients (mean age, 62+/-10 years; 271 men) 24 hours before and 1 hour after surgery. The primary end point of the study was the incidence of postoperative AF. Overall, postoperative AF occurred in 72 patients (18%). Eighty-eight patients (22%) showed an elevated perioperative NT-proBNP value. When patients with either preoperatively or postoperatively elevated NT-proBNP were pooled, a greater incidence of AF was observed compared with patients with normal values (64% versus 5%; P<0.001). At multivariable analysis, adjusted for age, gender, major comorbidities, echocardiography parameters, pneumonectomy, and medications, both preoperative and postoperative NT-proBNP values were independent predictors of AF (relative risk, 27.9; 95% CI, 13.2 to 58.9; P<0.001 for preoperative NT-proBNP elevation; relative risk, 20.1; 95% CI, 5.8 to 69.4; P<0.001 for postoperative NT-proBNP elevation).. Elevation of perioperative NT-proBNP is a strong independent predictor of postoperative AF in patients undergoing thoracic surgery for lung cancer. This finding should facilitate studies of therapies to reduce AF in selected high-risk patients.

Topics: Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Female; Humans; Incidence; Intraoperative Period; Lung Neoplasms; Male; Middle Aged; Postoperative Complications; Predictive Value of Tests; Prospective Studies; Protein Precursors; Risk Factors; Sensitivity and Specificity; Thoracic Surgical Procedures

Postoperative atrial fibrillation is associated with the increased incidence of morbidities and mortality. Predisposing determinants of atrial fibrillation development after off-pump coronary artery bypass grafting remain unclear. We hypothesized that pericardial fluid natriuretic peptide concentrations have a predictive value for developing postoperative atrial fibrillation in patients who have undergone off-pump coronary artery bypass grafting.. We prospectively measured atrial natriuretic peptide and brain natriuretic peptide concentrations in plasma and pericardial fluid in 42 consecutive patients undergoing off-pump coronary artery bypass grafting, then continuously observed the occurrence of atrial fibrillation following off-pump coronary artery bypass grafting until the time of discharge.. Postoperative atrial fibrillation was documented in nine patients (21%, atrial fibrillation group), and not in 33 patients (no atrial fibrillation group). Between the groups, there was neither significant difference in plasma atrial natriuretic peptide concentrations nor in pericardial atrial natriuretic peptide concentrations. Plasma brain natriuretic peptide concentrations were comparable in both groups [56.2 (interquartile range 42.7-102.8) vs. 35.2 pg/ml (13.8-75.0), P=0.07]. Pericardial fluid brain natriuretic peptide concentrations were significantly higher in the atrial fibrillation group than in the no atrial fibrillation group [188.0 (124.8-411.0) vs. 39.3 pg/ml (10.0-88.4), P=0.0001]. In a multivariable logistic regression model, pericardial brain natriuretic peptide concentration was significantly associated with a higher risk of postoperative atrial fibrillation (odds ratio=3.0 every 50 pg/ml increase; 95% confidence interval, 1.1-8.6; P=0.04).. Our results suggested that pericardial fluid brain natriuretic peptide concentration is independently associated with the development of atrial fibrillation after off-pump coronary artery bypass grafting.

Topics: Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Coronary Artery Bypass, Off-Pump; Extracellular Fluid; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Pericardium; Postoperative Complications; Prognosis

Atrial fibrillation is common in chronic heart failure. Long-term restoration of sinus rhythm is generally unsuccessful. It may be speculated that higher heart rates are unfavorable, since this may lead to tachycardiomyopathy, but there are no data which have examined this.. Seventy-seven patients with atrial fibrillation and advanced chronic heart failure, age 70 +/- 7 years, left-ventricular ejection fraction 0.23 +/- 0.08, 61% with ischemic etiology were included. Patients were dichotomized according to the median heart rate (80 bpm) at inclusion (39 patients with "low" heart rate and 38 patients with "high" heart rate). At baseline, both patient groups were remarkably comparable. After a mean follow-up of 3.3 +/- 0.9 years, mortality was comparable (62% versus 55%, p = non-significant). An independent relation was found between lower heart rate and survival, in addition to absence of hypertension, digoxin use, and higher N-ANP, dopamine, and renin levels.. In the present analysis, patients with atrial fibrillation and advanced chronic heart failure with higher heart rates are comparable to those with lower heart rates. Not higher heart rates at baseline but, on the contrary, lower heart rates seem associated with a worse outcome.

Topics: Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Dopamine; Female; Heart Failure; Heart Rate; Humans; Male; Middle Aged; Neurotransmitter Agents; Proportional Hazards Models; Renin

Aortic stenosis (AS) and atrial fibrillation (AF) are commonly encountered in clinical practice. Natriuretic peptides (NP) are endogenous cardiac hormones, which have been shown to increase in patients with heart failure, and valvular or congenital heart disease. We aimed to determine the association between atrial NP (ANP) and late postoperative AF after surgery for AS along with temporal changes in plasma ANP levels and left atrial (LA) volumes.. 22 patients (16 males/6 females, mean age: 61 years) with symptomatic AS and 8 healthy volunteers (5 males/3 females) were enrolled into our study. All the patients studied underwent transthoracic echocardiography, which was repeated during the follow-up. N-terminal ANP (N-ANP) was studied initially and at the 2-month follow-up. Postoperatively, the patients were followed up for 12 months for AF attacks.. Patients with AS had significantly higher levels of N-ANP, left ventricular (LV) end-diastolic pressure, E/A ratio, LV mass and LA volumes compared to the controls. Patients with postoperative AF attacks were significantly older, had higher N-ANP levels and LV end-diastolic pressure in addition to higher LA volumes and longer symptom duration compared to patients without AF. Age at the time of operation (p = 0.011) and N-ANP at the 2nd month (p = 0.047) were found to be independent predictors for late AF attacks during follow-up in regression analysis. Besides, N-ANP (p < 0.001) at the 2-month follow-up independently predicted impaired LA remodeling.. ANP might be an important factor to identify AS patients at risk for late postoperative AF attacks.

Topics: Aortic Valve Stenosis; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Chi-Square Distribution; Electrocardiography, Ambulatory; Female; Heart Atria; Humans; Male; Middle Aged; Predictive Value of Tests; Statistics, Nonparametric

The aim of the study is to find out the efficacy of radiofrequency catheter atrial ablation (RF) simultaneously done with mitral valve replacement (MVR) surgery in patients having rheumatic mitral valve disease with chronic atrial fibrillation and to evaluate the short-term postoperative results.. Seventeen patients underwent MVR surgery, and intraoperative RF procedures were done simultaneously with MVR to eight of these patients, whereas remaining nine of them were assigned to control group. Patients were assessed preoperatively, at time of discharge, and 1st, 6th and 12th months controls. Atrial and ventricular functions were evaluated with echocardiography, serum atrial natriuretic peptide (ANP) levels were investigated and electrocardiograms were recorded in all patients.. Demographically there were no significant differences between two groups. Radiofrequency ablation group had longer aortic cross-clamping and cardiopulmonary bypass times. Sinus rhythm was established in seven patients of RF group at postoperative 12th month. However, all patients of this group experienced sinus rhythm at postoperative sixth month whereas 'atrial kick' was detected in five of them. Significantly increased ejection fraction, decreased pulmonary artery pressure and decreased left atrial diameter were observed in RF group compared to control group. Serum ANP levels were found to be significantly decreased as compared to preoperative periods in both groups.. Although RF ablation has higher costs, this technique is efficient and useful to restore the sinus rhythm and to recover the atrial functions back in patients having rheumatic mitral valve disease.

Topics: Adult; Atrial Fibrillation; Atrial Natriuretic Factor; Catheter Ablation; Combined Modality Therapy; Female; Heart Function Tests; Humans; Intraoperative Complications; Male; Mitral Valve; Postoperative Complications; Time Factors; Treatment Outcome

It has been reported that plasma atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) levels are elevated in patients with atrial fibrillation (AF). The aim of this study was to investigate the change in these patients after pulmonary vein isolation (PVI). In 66 patients with paroxysmal AF (PAF) and without any structural heart disease, plasma ANP and BNP levels were measured before and 3 months after successful PVI. At baseline, in 14 patients, ANP and BNP levels were elevated, and in 52 patients, only BNP levels were elevated. There were no significant relations between the attack frequency or the duration of PAF episodes and ANP or BNP levels. Neither ANP nor BNP level at baseline was a valid predictor of AF recurrence. Even in 31 patients (47%) with recurrent PAF, attacks of PAF were significantly reduced. In 66 patients with elevated ANP and/or BNP levels at baseline, levels were significantly reduced after PVI independent of PAF recurrence (ANP: 69.0+/-23.0 vs 25.0+/-7.7 pg/ml, p<0.0001; BNP: 58.4+/-50.7 vs 22.5+/-27.1 pg/ml, p<0.0001). In 42 patients without AF recurrences, ANP and BNP levels were reduced to within the normal range. In conclusion, in patients with PAF without any structural heart disease, ANP and/or BNP levels were elevated. In those patients, relief of the AF burden by successful PVI significantly reduced elevated plasma ANP and BNP levels.

Topics: Atrial Fibrillation; Atrial Natriuretic Factor; Catheter Ablation; Female; Follow-Up Studies; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Pulmonary Veins; Recurrence; Retreatment

To study the determinants of natriuretic peptides in advanced chronic heart failure (CHF) patients with and without atrial fibrillation (AF) and to evaluate the prognostic value of natriuretic peptides in AF compared with sinus rhythm patients with advanced CHF.. The study group comprised 354 advanced CHF patients [all New York Heart Association (NYHA) III/IV], including 76 AF patients. AF patients were older (70+/-7 vs. 67+/-8; P=0.01), and non-ischaemic CHF was more common (42 vs. 19%; P=0.002) than in sinus rhythm patients, but left-ventricular ejection fraction was comparable (0.23+/-0.08 vs. 0.24+/-0.07; P=ns). At baseline, (NT-)ANP and NT-proBNP levels were significantly higher in AF patients, compared with those in sinus rhythm. By multivariate regression analysis, AF was identified as independent determinant of (NT-)ANP, but not of (NT-pro)BNP levels. After a mean follow-up of 3.2+/-0.9 (range 0.4-5.4) years, cardiovascular mortality was comparable (55 vs. 47%; P=ns). In both groups, AF and sinus rhythm, NT-proBNP [AF: adjusted HR 5.8 (1.3-25.4), P=0.02; sinus rhythm: adjusted HR 3.1 (1.7-5.7), P<0.001] was an independent risk indicator of cardiovascular mortality.. In advanced CHF patients, AF affects (NT-)ANP levels, but not (NT-pro)BNP levels. NT-proBNP is an independent determinant of prognosis in advanced CHF, irrespective of the rhythm, AF, or sinus rhythm.

Topics: Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Data Interpretation, Statistical; Female; Heart Failure; Humans; Male; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prognosis; Protein Precursors; Randomized Controlled Trials as Topic

Severe idiopathic tricuspid regurgitation (TR) occurs in the aged, but the mechanism of TR is unclear and there is little information on atrial abnormalities associated with this condition. This study retrospectively analyzed patients with severe functional TR presenting with common clinical features suggesting a distinct syndrome.. Eleven patients with severe functional TR were identified by reviewing the records of 16,235 consecutive patients. All patients had undergone clinical evaluation including echocardiography, electrocardiography and laboratory data.. The median age of patients with severe functional TR was 78 years. All had a long-standing history of atrial fibrillation (median duration, 23 years). Clinical features are characterized by severe functional TR due to annular dilation, markedly dilated right atrium, episodes of right-sided heart failure, absent or diminished fibrillation waves on electrocardiogram, bradycardia probably due to partial atrial standstill, and decreased atrial natriuretic peptide secretion. During long-term follow up, right atrial size progressively increased in association with worsening TR.. Severe functional TR occurs with long-standing atrial fibrillation and causes right-sided heart failure. The TR is caused by tricuspid valve systolic coaptation loss due to tricuspid annular dilation associated with atrial dilation. This condition is associated with atrial abnormalities, such as atrial standstill and impaired atrial natriuretic peptide secretion. We propose that atrial remodeling associated with atrial fibrillation is central to the occurrence of the syndrome.

Topics: Aged; Aged, 80 and over; Atrial Fibrillation; Atrial Natriuretic Factor; Female; Follow-Up Studies; Heart Atria; Heart Failure; Humans; Male; Retrospective Studies; Severity of Illness Index; Syndrome; Tricuspid Valve Insufficiency

We sought to characterize natriuretic peptide levels in a cohort of rigorously characterized subjects with lone atrial fibrillation (AF).. Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) are sensitive biomarkers of cardiac contractile dysfunction. Both peptides have been reported to be elevated in cohorts with AF, but previous studies have included subjects with underlying structural heart disease. We studied these hormones in 150 subjects with lone AF.. Study subjects had electrocardiographic evidence of at least one episode of AF and a structurally normal heart on echocardiography. Subjects were excluded if they had a history of a myocardial infarction, rheumatic heart disease, cardiomyopathy, significant valvular disease, hyperthyroidism, or hypertension that preceded the onset of AF. Control subjects were obtained from a healthy outpatient primary care population. Plasma pro-ANP and N-terminal pro-BNP (nt-pro-BNP) levels were determined using commercially available immunoassays.. A total of 150 serial subjects with lone AF were enrolled and studied, the majority during normal sinus rhythm. Median levels of nt-pro-BNP were significantly elevated in subjects with lone AF as compared with control subjects (166 vs. 133 fmol/ml, p=0.0003). There was no significant difference in pro-ANP levels between subjects with lone AF and control subjects (1,730 vs. 1,625 fmol/ml, p=0.90).. Discordant natriuretic peptide levels were observed in this homogeneous population of subjects with lone AF. This biomarker pattern, which is present even in sinus rhythm, may represent an underlying subclinical predisposition to this common arrhythmia.

Topics: Adult; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Electrocardiography; Female; Humans; Immunoassay; Male; Middle Aged; Natriuretic Peptide, Brain; Ultrasonography

Atrial dilatation is an important risk factor for atrial fibrillation (AF). In the present study, we monitored the electrophysiological changes during progressive atrial dilatation in chronically instrumented goats.. In 8 goats, 2 screw-in leads with piezoelectric crystals were implanted transvenously in the right atrium. After 2 weeks, atrial diameter and effective refractory period were measured. AF paroxysms were induced by burst pacing to determine the baseline AF cycle length and stability of AF. After His-bundle ablation, the above measurements were repeated once a week. After 4 weeks of complete AV block, the free wall of the right atrium was mapped and the atrium was fixed in formalin for histological analysis. After His-bundle ablation, the ventricular rate decreased from 113.8+/-4.8 to 44.6+/-2.5 bpm. Right atrial diameter increased gradually by 13.5+/-3.9% during 4 weeks of AV block (P<0.01). The duration of induced AF paroxysms increased from 4.6 seconds to 6.4 minutes (P<0.05). Atrial effective refractory period and AF cycle length remained constant. Spontaneous paroxysms of AF were not observed. Atrial mapping during rapid pacing revealed that slow conduction (<30 cm/s) was present in 3.7+/-1.0% of the mapped area (control, 0.9+/-0.5%, P<0.05). Histological analysis showed hypertrophy without atrial fibrosis. Connexin40 and connexin43 expression was unchanged.. Chronic AV block in the goat leads to progressive atrial dilatation, prolongation of induced AF paroxysms, and local conduction delays. The increase in AF stability was not a result of a shortening of atrial refractoriness or atrial fibrosis.

Topics: Aldosterone; Angiotensin II; Animals; Atrial Fibrillation; Atrial Natriuretic Factor; Cardiac Pacing, Artificial; Cardiomegaly; Cell Size; Chronic Disease; Connexin 43; Connexins; Female; Gap Junction alpha-5 Protein; Goats; Heart Block; Heart Conduction System; Hemodynamics; Hypertrophy; Myocytes, Cardiac; Neural Conduction; Norepinephrine; Refractory Period, Electrophysiological

Atrial fibrillation (AF) may be associated with activation of atrial natriuretic peptide (ANP). The exact trigger for the release of ANP is still being debated. Atrial volume, pressure, and wall stretch are considered to be the main determinants of ANP activation. The aim of the study was to evaluate plasma ANP concentrations in patients with persistent AF and to analyze the echocardiographic determinants of ANP concentration in this group. The study population included 67 patients, 59 +/- 7 years of age, with a median AF duration of 5.5 months (range 0.1-12). The relationship between plasma ANP concentrations and echocardiographic left atrial (LA) diameter and volume, and left ventricular (LV) diameter and ejection fraction (EF) was analyzed by logistic regression analysis. The median baseline plasma ANP concentration was 63 pg/mL (range 21-126) in the study group versus 34 pg/mL (range 16-73) in a control group. The mean left antero-posterior atrial dimension, LA volume, LV enddiastolic diameter, and LVEF were 48 mm, 104 mL, 52 mm, and 54%, respectively. A significant linear positive correlation was found between plasma ANP concentration and maximal LA volume (r = 0.62, P < 0.01). A negative correlation was found between LVEF and plasma ANP concentration (r =-0.42, P = 0.01). However, by multivariate regression analysis, no echocardiographic parameter was an independent predictor of plasma ANP concentration. Plasma ANP concentrations were independent of echocardiographic measurements of LA size or LV size and function in patients with persistent AF.

Topics: Adult; Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Female; Heart Atria; Heart Ventricles; Humans; Male; Middle Aged; Ultrasonography; Ventricular Function, Left

We prospectively determined the time course of recovery of atrial mechanical and endocrine function in patients following DC cardioversion for persistent atrial fibrillation (AF). Twenty-three consecutive patients underwent successful DC cardioversion (mean age 64 years, 20 male). By 28 days, nine had reverted to atrial fibrillation. Recovery of atrial mechanical (peak A wave velocity) and endocrine function (atrial natriuretic peptide, ANP) were assessed at four time points: immediately pre-cardioversion, and then 4 h, 7 and 28 days post. The 14 patients maintaining sinus rhythm formed the success group. In this group, peak A wave velocity increased significantly over time from 0.28+/-0.03 m/s (mean+/-S.E.M.) at 4 h to 0.50+/-0.03 m/s at day 7 and 0.67+/-0.05 m/s at day 28 (p<0.001). Plasma ANP was 150+/-34 pg/ml immediately prior to DC cardioversion in the success group. This showed an initial dip at 4 h to 44+/-9 pg/ml (p<0.001). By day 7, plasma ANP had increased to 105+/-21 pg/ml (p<0.05 vs. baseline and 4 h) and then appeared to remain constant, being 102+/-19 pg/ml at day 28 (p=0.06 vs. baseline). A similar early reduction in ANP levels was seen in the group who subsequently reverted to atrial fibrillation. Baseline ANP levels did not predict subsequent successful maintenance of sinus rhythm. Initial "stunning" in both atrial mechanical and endocrine function occurs in patients following DC cardioversion for atrial fibrillation. Whilst endocrine function appears to fully recover by day 7, mechanical function continues to improve beyond day 7.

Topics: Aged; Aged, 80 and over; Atrial Fibrillation; Atrial Natriuretic Factor; Chronic Disease; Electric Countershock; Endocrine System; Female; Heart Atria; Humans; Male; Middle Aged; Prospective Studies; Recovery of Function; Time Factors

Atrial fibrillation (AF) is a common arrhythmia with important therapeutic and prognostic implications. An attempt to restore sinus rhythm is considered in most patients with AF. The aim of this study was to assess the value of echocardiographic examination and plasma atrial natriuretic peptide (ANP) evaluation in predicting the outcome of cardioversion and maintenance of sinus rhythm in patients with persistent AF.. Eighty-one consecutive patients, aged 62+/-9 years, with AF of duration 4.7 months were subjected to an echocardiography examination and ANP assessment before cardioversion. The patients were predominantly hypertensive men with moderately enlarged left atrium and ejection fraction of left ventricle of about 50%. All patients were in controlled AF and had normalized blood pressure. In order to predict the outcome of cardioversion, and maintenance of sinus rhythm over a 1 month period, a multivariate logistic regression method was performed using the following variables: left atrial and left ventricular dimensions, left ventricular ejection fraction and plasma ANP levels.. Sixty-nine out of the 81 patients were successfully converted to sinus rhythm. At 1 month 57 patients remained in sinus rhythm. There were no statistical differences between sinus rhythm and AF group in baseline ANP levels (59.4 vs 64.2 pg/ml, consecutively), clinical and echocardiographic characteristics. In logistic regression analysis neither baseline echocardiographic variable nor ANP level, predicts successful cardioversion over a 1-month period of observation.. Echocardiographic data and ANP level should not be included as an important variable when considering patients for cardioversion.

Topics: Atrial Fibrillation; Atrial Natriuretic Factor; Drug Evaluation, Preclinical; Electric Countershock; Female; Humans; Logistic Models; Male; Middle Aged; Predictive Value of Tests; Treatment Outcome; Ultrasonography

In patients with atrial fibrillation (AF) information regarding exercise release of atrial natriuretic peptide (ANP) is sparse and data on plasma brain natriuretic peptide (BNP) response to exercise is lacking. The aim of this study was to investigate plasma ANP and BNP response to exercise in patients with permanent AF and to assess if the response was different from the response in healthy age- and sex-matched control subjects.. Plasma venous concentrations of ANP and BNP were determined at rest, at peak exercise and 30 min from the end of exercise in 38 patients with permanent AF and in 43 age- and sex-matched healthy control subjects.. Plasma concentrations of ANP and BNP were significantly higher in AF patients compared with the healthy control group at rest, peak exercise and after 30 min of recovery (p<0.0001). ANP and BNP increased significantly during exercise in both patients with AF and in the healthy control subjects (p<0.05). The increase in plasma concentration of ANP and BNP during exercise was significantly higher in AF patients compared with healthy controls (p=0.0002 for ANP; p<0.0001 for BNP). In the recovery period plasma BNP decreased significantly (p<0.0001) where as the decrease in plasma ANP was insignificant (p=0.4).. Patients with permanent AF have elevated levels of ANP and BNP at rest and exhibit much higher exercise release compared to healthy control subjects. This enhanced secretion of potent vasodilating and natriuretic agents may represent an important compensatory mechanism to improve exercise capacity in patients with AF.

Topics: Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Blood Pressure; Exercise; Exercise Test; Female; Heart Rate; Humans; Male; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain; Oxygen Consumption; Physical Endurance; Predictive Value of Tests; Stroke Volume

Atrial natriuretic peptide (ANP) may alter electrophysiological properties of the heart and possibly have a role in arrhythmogenesis. However, previous studies have yielded conflicting results and have not fully considered whether ANP's cardiac electrophysiological effects are mediated via direct actions and/or indirectly via the autonomic nervous system. This study's aim was to establish whether ANP infused at pathophysiological and pharmacological doses has significant in vivo cardiac electrophysiological effects and to determine whether these effects are directly or autonomically mediated.. Electrophysiologic and hemodynamic effects of ANP infusion (human ANP at 15-600 ng/kg per minute) were examined in chloralose-anesthetized dogs under conditions of varying autonomic blockade. In autonomically intact dogs (n = 12), low-dose ANP (15 ng/kg per minute) shortened atrial effective refractory period (ERP) (P < 0.001) and monophasic action potential duration (MAPD90) (P < 0.05) at 600, 500, and 400 msec atrial paced cycle lengths and reduced right atrial pressure (P < 0.05) but did not alter mean arterial pressure. After either combined vagal and beta-adrenergic blockade (vagotomy plus atropine plus propranolol, n = 7) or selective vagal blockade (n = 9), low-dose ANP no longer altered atrial ERP or MAPD90. Higher ANP doses (150 and 600 ng/kg per minute) decreased mean arterial and right atrial pressures (P < 0.001) but did not alter atrial ERP, MAPD90, or other electrophysiological parameters including atrial fibrillation threshold, ventricular ERP, and MAPD90.. ANP has dose-dependent, autonomically mediated effects on atrial refractoriness and repolarization.

Topics: Action Potentials; Animals; Atrial Fibrillation; Atrial Function; Atrial Natriuretic Factor; Dogs; Electrophysiologic Techniques, Cardiac; Heart Atria; Hemodynamics; Models, Animal

In the present study, we have examined whether increased N-ANP (N-terminal pro-ANP) levels before and after surgery in patients with ASD (atrial septal defect) along with echocardiographic findings provide a better insight into the pathophysiology and increased morbidity and mortality following corrective surgery. Eighteen adult ASD patients (> 20 years of age; six male and 12 female) with shunts (Qp/Qs > or = 2, where Qp/Qs is the pulmonary blood flow/systemic blood flow) had complete echocardiographic, clinical and laboratory parameters evaluated before and 6 months after surgery. Eight age- and sex-matched individuals (three male and five female) were enrolled as a control group. Blood samples for N-ANP analysis were obtained in both groups. N-ANP levels in the peripheral blood sample from ASD patients before surgery were significantly higher than those in the control group. In patients with ASD, mean N-ANP levels obtained from the pulmonary artery were significantly higher than that obtained from the peripheral vein. RA (right atrial) area, adjusted for body surface area, and RA long-axis and short-axis measurements were significantly higher in the patient group than the control group. N-ANP was correlated significantly with these parameters. Following corrective surgery, N-ANP values and RA area, RA long-axis and short-axis normalization decreased significantly and were accompanied by a decrease in systolic mean pulmonary artery pressure. N-ANP levels were normalized following septal closure in most patients, except in those with atrial fibrillation attacks following corrective surgery. In conclusion, we have shown correlations among variables indicating changes in the architecture of the right atrium along with temporal changes in ANP providing insights into the pathophysiology of post-operative atrial arrhythmias.

Topics: Adult; Atrial Fibrillation; Atrial Natriuretic Factor; Chi-Square Distribution; Echocardiography; Female; Heart Septal Defects, Atrial; Humans; Male; Postoperative Complications

Topics: Amyloid; Amyloidosis; Atrial Fibrillation; Atrial Function; Atrial Natriuretic Factor; Cardiomyopathies; Echocardiography; Heart Atria; Heart Valve Diseases; Humans

The hemodynamic consequences of atrial fibrillation (AF) may lead to impairment of the left ventricular function and a reduction in exercise capacity. Studies on mechanical and neurohormonal remodelling in patients with AF are becoming increasingly important. The results could possibly enhance treatment strategies of these patients. The aim of this study was to assess changes in exercise capacity, echocardiographic findings and plasma atrial natriuretic peptide (ANP) concentrations in patients with non-rheumatic persistent AF, before and 30 days after successful cardioversion.. We attempted cardioversion in 42 consecutive patients, aged 58 +/- 8 years, with persistent non-valvular AF of duration 7.1 +/- 7.1 months. They underwent echocardiography examination and submaximal exercise testing 24 h before and 30 days after cardioversion. Exercise capacity was determined during symptom-limited exercise testing, according to a modified Bruce protocol with peak VO2 analysis. Plasma samples of ANP were obtained at rest: before, the day after, and 30 days after cardioversion therapy, and were prepared by refrigerated centrifugation and stored until radioimmunoassay. The control study group, without AF, comprised of 11 subjects.. Cardioversion was successful in 35 patients. However, in six of the 35 patients, AF reappeared within 1 month. There were no statistical differences before cardioversion in exercise tolerance and ejection fraction of left ventricle between the group with successful cardioversion and the group with unsuccessful cardioversion or with recurrence of AF. On the 30th day after cardioversion we recorded a significant increase in exercise tolerance: duration of exercise 13.7 +/- 3.2 versus 9.5 +/- 3.4 min, (P < 0.05); peak oxygen consumption 32.2 +/- 3.6 versus 19.85 +/- 3.5 ml/min per kg, (P < 0.05); and ejection fraction of left ventricle 58.6 +/- 9.4 versus 52.7 +/- 10.2% (P < 0.05); in the sinus rhythm group. There was no significant improvement observed in the AF group. The mean baseline ANP level was 58.5 +/- 15.7 pg/ml in the study group and 34.3 +/- 10.2 pg/ml in the control group (P < 0.01). The successful therapy reduced significantly the pretreatment mean plasma ANP concentration from 58.5 +/- 15.7 to 31.4 +/- 15.0 pg/ml, (P < 0.01); the day after cardioversion, in the group of 35 patients. It remained stable for the next 30 days (36.9 +/- 15.2 pg/ml) in the group of 29 patients who remained in sinus rhythm, and increased to 53.4 +/- 16.4 pg/ml in the group of six patients who had recurrence of AF. Plasma ANP did not change in the group of seven patients with unsuccessful cardioversion.. The restoration of sinus rhythm in patients with persistent AF was associated with a significant improvement in cardiac performance and exercise tolerance 1 month after cardioversion. Such improvement was not observed in the group with unsuccessful cardioversion or with AF recurrence. The plasma ANP concentration in patients with AF was significantly reduced after successful cardioversion and remained stable for a period of 30 days.

Topics: Aged; Analysis of Variance; Atrial Fibrillation; Atrial Function, Left; Atrial Natriuretic Factor; Biomarkers; Case-Control Studies; Chronic Disease; Echocardiography, Doppler; Electric Countershock; Exercise Tolerance; Female; Humans; Male; Middle Aged; Probability; Prognosis; Reference Values; Sensitivity and Specificity; Treatment Outcome

Plasma concentration of atrial natriuretic peptide (ANP) is elevated in patients with atrial fibrillation (AF) and in patients with chronic heart failure (CHF).Aim. To assess ANP level in patients with permanent AF and advanced CHF.. The study group consisted of 41 patients (27 males, mean age 62+/-8 years) with AF of a mean duration of 8.8 months. Twenty six (63%) patients were in NYHA class II, and 15 (37%) - in NYHA class III or IV. All patients underwent clinical and echocardiographic evaluation as well as ANP plasma concentration assessment. Multiple regression analysis was used to identify factors which determine ANP plasma concentration.. Mean ANP plasma concentration was 52.4+/-22.7 pg/ml in the whole study group; 38.6+/-10.8 pg/ml in NYHA class II patients and 74.9+/-18.7 pg/ml in NYHA class III-IV subjects (p<0.0001). Among echocardiographic parameters, patients with NYHA class III or IV had significantly lower left ventricular ejection fraction and greater left atrial volume than patients with NYHA class II (32% versus 56%, p<0.0001 and 101.0+/-23.8 cm(3) versus 83.4+/-16.1 cm(3), p<0.006, respectively). Multiple regression analysis revealed a significant negative correlation between AF duration and ANP level (p=0.0013) in a group of patients with NYHA class III or IV and identified AF duration as an independent predictor of ANP plasma concentration in this group of patients.. ANP plasma concentration in patients with persistent AF and advanced CHF is determined by AF duration - the longer the AF duration the lower the ANP level.

Topics: Adult; Aged; Aged, 80 and over; Atrial Fibrillation; Atrial Natriuretic Factor; Female; Heart Failure; Humans; Male; Middle Aged; Severity of Illness Index; Time Factors

Clinical results of the Maze procedure for treatment of atrial fibrillation (AF) are excellent, suggesting improved ventricular function after restoring sinus rhythm. However, long-term corresponding effects on the release of cardiac natriuretic peptides and other vasoactive hormones are incompletely investigated after isolated Maze surgery.. Plasma levels of brain natriuretic peptide (BNP), atrial natriuretic peptide (ANP), antidiuretic hormone, aldosterone, and angiotensin II were measured in 15 patients (mean age, 52 +/- 11 years) undergoing isolated surgical Maze (III) procedures for medically refractory AF, preoperatively and 6 months postoperatively. At the time of blood sampling, hemodynamic correlates were obtained at baseline and after 6 and 12 minutes of rapid ventricular pacing at 150 stimulations/minute.. All patients were free of AF at 6-month follow-up. The measured plasma levels of BNP, ANP, and angiotensin II were all significantly lower (p = 0.03) late after the isolated Maze procedure. Cardiac output was significantly higher postoperatively (p < 0.01). Other hemodynamic values and left atrial size were unchanged after surgery. Ventricular pacing caused almost identical hemodynamic changes in atrial pressures before and late after surgery, but the associated plasma ANP response was significantly attenuated postoperatively (p < 0.001).. Levels of cardiac natriuretic peptides and angiotensin II as markers of ventricular function are improved in the long term after clinically successful isolated Maze procedures. ANP response to hemodynamic challenge by ventricular pacing was attenuated postoperatively, possibly due to atrial scarring.

Topics: Adult; Aged; Aldosterone; Angiotensin II; Atrial Fibrillation; Atrial Natriuretic Factor; Chronic Disease; Cryosurgery; Female; Follow-Up Studies; Hemodynamics; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Neurotransmitter Agents; Postoperative Complications; Vasopressins; Ventricular Dysfunction, Left; Ventricular Function, Left

In drug refractory and highly symptomatic atrial fibrillation (AF) patients, hemodynamic effects of AV node ablation and pacing therapy (APT) were evaluated. Thirty-eight patients with drug refractory and symptomatic AF, underwent APT in eight centers in Japan. The outcome of this therapy was assessed in terms of quality-of-life, cardiac performance measured by echocardiogram, and plasma ANP and BNP levels before and after APT. Quality-of-life assessed by self-administered semi-quantitative questionnaires: WHO QOL 26 (3.0 +/- 0.5 vs 3.4 +/- 0.6, P < 0.01) and the Symptom Checklist: Frequency Scale (1.6 +/- 0.6 vs 0.7 +/- 0.7, P < 0.01) and Severity Scale (1.3 +/- 0.4 vs 0.6 +/- 0.6, P < 0.01), improved significantly 6 months after APT. Ejection fraction (EF) by echocardiogram improved 1 week after APT (59.0% +/- 13.3% vs 63.3% +/- 11.6%, P = 0.02). Plasma ANP levels in the group of ANP > 40 pg/mL at enrollment significantly decreased 1 month later (P = 0.03), and plasma BNP levels in the group of BNP > 20 pg/mL at enrollment significantly decreased 1 month later (P < 0.01). In conclusion, APT has beneficial hemodynamic effects, and plasma BNP levels can predict the most optimal candidates for ablation and pacing therapy.

Topics: Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Atrioventricular Node; Catheter Ablation; Echocardiography; Female; Hemodynamics; Humans; Male; Natriuretic Peptide, Brain; Pacemaker, Artificial; Quality of Life; Statistics, Nonparametric; Treatment Outcome

The purpose of this study was to evaluate left atrial mechanical function recovery and plasma atrial natriuretic peptide (ANP) release following successful cardioversion of persistent atrial fibrillation (AF).. Atrial fibrillation is characterized by functional deterioration, loss of atrial contraction, and elevation of plasma ANP levels. The response of ANP release toward atrial mechanical function after cardioversion of AF has not been fully examined.. We examined 29 patients with successfully cardioverted persistent AF in whom sinus rhythm was maintained for at least 30 days after cardioversion. We assessed mechanical function of the left atrium at 24 h and 7 and 30 days after cardioversion and evaluated plasma ANP level at the same time. Atrial mechanical function was assessed during echocardiographic examination by means of the peak velocity of the transmitral A-wave, early transmitral to atrial flow velocity ratio, and atrial filling fraction (AFF). The plasma ANP level was determined by the radioimmunoassay method.. Plasma ANP levels were significantly reduced from 59.4 +/- 16.6 pg/ml to 31.1 +/- 9.2 pg/ml at 24 h after successful cardioversion. Within 30 days, we noted progressive improvement of atrial systolic function (increase in AFF from 21% to 31%, p < 0.05). At the same time, plasma ANP levels gradually increased from 31.1 +/- 9.2 pg/ml at 24 h to 36.9 +/- 12.8 pg/ml on day 30 following cardioversion (p < 0.05).. Plasma ANP levels significantly decreased in patients with persistent AF after successful cardioversion. In the 30 days after cardioversion, gradual elevation of plasma ANP concentration was observed concomitantly with an increase of AFF. Plasma ANP release after successful cardioversion of persistent AF might be due to recovery of atrial mechanical function.

Topics: Atrial Fibrillation; Atrial Function, Left; Atrial Natriuretic Factor; Echocardiography; Echocardiography, Doppler; Electric Countershock; Female; Humans; Male; Middle Aged; Myocardial Contraction; Stroke Volume; Ventricular Function, Left

Previous reports indicate that plasma levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) increase in atrial fibrillation (AF), but decrease after successful direct current (DC) cardioversion. Although the maze procedure is the only curative therapy for AF, the effects on atrial and left ventricular function remain unclear. The study aim was to determine whether plasma ANP and BNP levels decrease after the maze procedure in patients with mitral valve disease.. Twenty-seven patients either with (n = 23) or without (n = 4) AF underwent mitral valve surgery; of these patients, 13 underwent a maze procedure for chronic AF. Blood samples and echocardiographic data were obtained before and at one year after surgery.. Ten patients with AF achieved sinus rhythm (SR) or junctional rhythm after the maze procedure. In patients subjected to mitral valve surgery, mean plasma levels of ANP and BNP were 59.8 +/- 11.9 and 139.2 +/- 53.7 pg/ml, respectively. ANP and BNP plasma levels fell significantly after surgery (to 32.1 +/- 4.1 and 46.7 +/- 10.2 pg/ml, respectively; p = 0.04 and p = 0.004). In patients with successful maze procedure, plasma levels of BNP and left ventricular end-diastolic dimension (LVDd) were significantly decreased by 35.7% and 82.7% compared with preoperative values (BNP, 35.7 +/- 4.9% for SR versus 83.4 +/- 9.6% for AF, p = 0.008; LVDd, 82.7 +/- 3.7% for SR versus 97.0 +/- 3.2% for AF, p = 0.0159).. A successful maze procedure significantly decreased LVDd and plasma levels of BNP after surgery. These results show that the maze procedure is effective in improving left ventricular diastolic dysfunction for a mid-term period in patients with mitral valve disease.

Topics: Adult; Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Chronic Disease; Cohort Studies; Electric Countershock; Female; Heart Valve Prosthesis Implantation; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Mitral Valve Stenosis; Natriuretic Peptide, Brain; Probability; Prognosis; Regression Analysis; Retrospective Studies; Sensitivity and Specificity; Severity of Illness Index; Treatment Outcome

Topics: Adult; Aged; Atrial Fibrillation; Atrial Function, Left; Atrial Natriuretic Factor; Biomarkers; Blood Pressure; Diastole; Echocardiography, Doppler; Electric Countershock; Female; Heart Atria; Humans; Male; Middle Aged; Predictive Value of Tests; Recovery of Function; Statistics as Topic; Stroke Volume; Systole

To investigate the role of kaliuretic peptide (KP) and molar ratio of KP/ atrial natriuretic peptide (ANP) in atrial fibrillation.. The levels of plasma KP and ANP in 23 patients with paroxysmal atrial fibrillation (group I), 24 patients with persistent atrial fibrillation (>1 year, group II) and 20 healthy humans (group III) were determined with radioimmunoassay.. Compared with group III, the levels of plasma KP and ANP of the group I and group II were both higher (both P<0.01). Compared with group III, the level of KP/ANP of the group I was lower (P<0.01), while that of group II was no substantial change (P>0.05).. The change of levels in ANP, KP and ANP/KP may play important role in atrial fibrillation.

Topics: Atrial Fibrillation; Atrial Natriuretic Factor; Humans; Natriuretic Peptides; Protein Precursors

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in clinical practice, affecting many millions of people world-wide. The treatment of AF has improved significantly during the past decade, but most patients suffer from symptoms and recurrences of arrhythmia. Studies on the neurohormonal remodelling in patients with AF are becoming increasingly important because they may improve the treatment of AF.. To determine plasma atrial natriuretic peptide (ANP) concentrations in patients with persistent AF, before and one day after electrical cardioversion of AF.. We attempted cardioversion in 42 consecutive patients (30 men and 12 women), aged 57+/-8 years, with persistent nonvalvular AF of 7+/-6 month duration. The underlying heart disease was systemic hypertension in 20, ischaemic heart disease in 17, dilated cardiomyopathy in 3, and lone AF in 2 patients. All patients had left ventricular ejection fraction >45%. The control group comprised 11 subjects with sinus rhythm and no history of AF who were age-, gender- and concomitant disease-matched with the AF patients. Plasma samples of ANP were obtained at rest the day before and 24 hours after cardioversion.. Cardioversion was successful in 35 patients. Patients with successful or non-successful cardioversion had similar clinical characteristics. The mean baseline ANP level before cardioversion was 59.5+/-15.6 pg/ml and was significantly higher than in the control group - 34.3+/-10.2 pg/ml (p<0.001). In patients in whom sinus rhythm was restored, a significant decrease in the ANP level was observed (59.4+/-16.6 versus 31.4+/-15.0 pg/ml; p<0.01) whereas it did not change in patients with ineffective cardioversion (59.4+/-10.7 versus 60.2+/-10.7 pg/ml, NS).. Plasma ANP concentration in patients with AF was significantly reduced after successful cardioversion and remained stable in those with unsuccessful cardioversion.

Topics: Atrial Fibrillation; Atrial Natriuretic Factor; Electric Countershock; Electrocardiography; Female; Heart Rate; Humans; Male; Middle Aged; Time Factors

Atrial fibrillation (AF) occurs in about 20% of patients with hypertrophic cardiomyopathy (HCM). HCM patients with AF have an increased risk for clinical decline and thromboembolism. In addition, AF is known to be associated with the atrial renin-angiotensin system (RAS). However, the relation between AF and the RAS in HCM has not been investigated. We genotyped the insertion/ deletion (I/D) polymorphism of the angiotensin-converting enzyme (ACE) gene in 138 HCM patients (26 with AF, 112 with sinus rhythm). Distribution of the ACE genotypes (DD, ID, and II) among the total HCM patients was 15%, 46%, and 38%. AF was documented in 3 patients with the DD genotype, 7 with the ID genotype, and 16 with the II genotype (P < 0.03 vs. sinus rhythm group). The odds of AF were 3.2-fold greater in patients with the II genotype than in those with the other genotypes (P = 0.009, 95% confidence interval = 1.3-7.8). Kaplan-Meier curves examining the time to the first documented AF event showed a significant difference between genotypes during the follow-up period (mean 116 months, P < 0.05). These findings suggest that the II genotype of the ACE gene is a significant risk factor for AF in patients with HCM.

Topics: Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Cardiomyopathy, Hypertrophic; Female; Gene Frequency; Genetic Predisposition to Disease; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptidyl-Dipeptidase A; Risk Factors

Structural changes, like atrial fibrosis, may increase the likelihood of atrial fibrillation (AF) occurring in response to triggering events. The influence of isolated atrial amyloidosis (IAA) is largely unknown.. Right atrial appendages (1 or 2 entire cross sections) were obtained from 245 patients undergoing open-heart surgery. Atrial amyloid was identified by Congo red staining and classified by immunohistochemistry. Amyloid was found in 40 (16.3%) of 245 patients, and all deposits were immunoreactive for atrial natriuretic peptide (ANP). Thirty-eight (15.5%) patients suffered from persistent AF. The presence of amyloid correlated with age and P-wave duration and was related to sex, valve diseases, and the presence of AF (P<0.01). The association between atrial amyloid, AF, and P-wave duration was independent of age and sex. According to multiple logistic regression analysis, amyloid was the only age- and sex-independent predictor for the presence of AF. Atrial fibrosis was not a predictor for AF, and the amount of amyloid correlated inversely with the degree of interstitial fibrosis (P=0.001; r=-0.55).. Our study provides evidence that IAA affects atrial conduction and increases the risk of AF. The occurrence of IAA depends on age leading to the formation of an amyloid nidus. The progression and consequences of IAA are then influenced by pathological conditions, such as valve diseases, that increase synthesis and secretion of ANP. The inverse correlation between IAA and atrial fibrosis suggests that these patients may not benefit from treatment with ACE inhibitors to reduce the amount of atrial fibrosis.

Topics: Adult; Aged; Amyloidosis; Atrial Appendage; Atrial Fibrillation; Atrial Natriuretic Factor; Female; Fibrosis; Heart Atria; Humans; Immunohistochemistry; Male; Middle Aged; Time Factors

We prospectively tested the hypothesis that atrial enlargement and increased level of atrial natriuretic peptide, N-terminal atrial natriuretic peptide and brain natriuretic peptide would predict atrial fibrillation after coronary artery bypass grafting.. Eighty-eight elective coronary artery bypass grafting patients had preoperative echocardiographic assessment. The level of atrial natriuretic peptide, N-terminal atrial natriuretic peptide and brain natriuretic peptide were measured preoperatively. Patients were ECG- monitored during the whole hospital stay.. Thirty one (35.2%) patients had postoperative atrial fibrillation. In univariate analysis increased age (P=0.003), enlargement of left and right atria (P=0.002 and P=0.004, respectively) and increased level of preoperative atrial natriuretic peptide and N-terminal atrial natriuretic peptide (P=0.016 and P=0.03, respectively) were associated with postoperative atrial fibrillation. There was correlation between the age and level of N-terminal atrial natriuretic peptide (r=0.45 and P<0.001). In multivariate analysis only age and the left atrial enlargement were independent predictors of postoperative atrial fibrillation (P=0.02 and P=0.01).. Left atrial enlargement was independent predictor for postoperative atrial fibrillation. However, atrial peptides were associated with age and did not independently predict postoperative atrial fibrillation. In addition, the wide variation of the peptide levels renders the implementation of this measure in clinical practice superfluous.

Topics: Age Factors; Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Coronary Artery Bypass; Coronary Disease; Female; Heart Atria; Humans; Male; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain; Prognosis; Prospective Studies; Protein Precursors; Risk Factors

We hypothesized that the plasma atrial natriuretic peptide (ANP) level reflects atrial degenerative change and may predict the outcome of the maze procedure.. Although a larger preoperative left atrial dimension and longer duration of atrial fibrillation (AF) have been reported in patients with persistent AF than in those with sinus rhythm (SR), these individual factors were not enough to predict the outcome of the maze procedure.. Preoperative plasma ANP levels were measured in consecutive 62 patients who underwent the Kosakai's modified maze procedure. Moreover, we performed histological and molecular biological examinations in the resected left atrial tissues.. The preoperative plasma ANP was lower in the AF group (n = 13) than it was in the SR group (n = 49) (p < 0.001). Multiple logistic regression analysis revealed that duration of AF and plasma ANP were independently associated with postoperative cardiac rhythm. Among 41 patients with a higher plasma ANP or shorter duration of AF than the median value, SR was restored in 95% of patients. In contrast, in 21 patients with a lower plasma ANP and a longer duration of AF than the median value, SR was restored only in 48% of patients. Histological examination revealed that the collagen volume in the left atrial tissue was higher in AF than it was in SR and inversely correlated with plasma ANP. In addition, the messenger RNA expressions of ANP, collagen type I and type III were lower in AF than they were in SR.. These results suggest that a combination of plasma ANP and/or duration of AF may predict the success rate for the maze operation. Advanced atrial degenerative change may result in a decrease of atrial ANP secretion.

Topics: Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Blotting, Northern; Collagen; Female; Heart Atria; Humans; Logistic Models; Male; Middle Aged; Sensitivity and Specificity

The relationship between the long-term efficacy of the antiarrhythmic agent cibenzoline in preventing lone paroxysmal atrial fibrillation (PAf) and plasma concentrations of atrial natriuretic peptide (ANP) and catecholamine was investigated during sinus rhythm and PAf.. Plasma concentrations of ANP, epinephrine, norepinephrine and dopamine during sinus rhythm and PAf were measured in 87 patients (70 men, 17 women, mean age 64 +/- 11 years) with lone-PAf. All patients received cibenzoline (300 mg/day) after cardioversion, and they were divided into the no recurrence group (n = 28) and the recurrence group (n = 59). Mean follow-up period was 41 +/- 29 months.. The plasma concentration of ANP was significantly higher during PAf (110.2 +/- 65.0 pg/ml) than during sinus rhythm (39.9 +/- 27.8 pg/ml, p < 0.01) for all patients. The concentrations of epinephrine, norepinephrine and dopamine during PAf were all similar to those during sinus rhythm. Patient characteristics showed no statistically significant difference between the no recurrence and recurrence groups. In the recurrence group, the incidence of thromboembolism was significantly higher (30.5% vs 10.7%) and the period of PAf was significantly longer (26.8 +/- 43.6 vs 12.4 +/- 21.2 months) than in the no recurrence group (both, p < 0.05). The plasma concentrations of ANP during sinus rhythm were similar in the no recurrence group (33.1 +/- 20.1 pg/ml) and the recurrence group (43.5 +/- 30.3 pg/ml), but was significantly higher during PAf in the no recurrence group (142.6 +/- 76.5 pg/ml) than in the recurrence group (95.8 +/- 54.2 pg/ml, p < 0.01). The ratio of ANP level during PAf to that during sinus rhythm in the no recurrence group (5.0 +/- 2.5) was significantly greater than that in the recurrence group (3.2 +/- 2.5, p < 0.01).. Patients without recurrence of PAf under treatment with cibenzoline have preserved capacity of ANP secretion compared with patients with recurrence.

Topics: Aged; Anti-Arrhythmia Agents; Atrial Fibrillation; Atrial Natriuretic Factor; Female; Humans; Imidazoles; Male; Middle Aged

Idiopathic bilateral atrial dilatation (IBAD) is an extremely rare anomaly and is usually associated with atrial fibrillation. Plasma levels of atrial natriuretic peptide (ANP) have been shown to increase in patients with atrial fibrillation. However, secretion of ANP and brain natriuretic peptide (BNP) in patients with IBAD remains unclear. We investigated the clinical features of 9 patients with IBAD and 16 age- and sex-matched patients with lone atrial fibrillation (LAF). Plasma levels of ANP and BNP were measured, and echocardiographic parameters were followed. Left (LAV) and right atrial volumes (RAV) were significantly higher in patients with IBAD than in patients with LAF (both p < 0.01). There were no differences between patients with IBAD and LAF in other echocardiographic parameters. The percent increases in LAV and RAV in patients with IBAD exceeded those in patients with LAF (both p < 0.01). Plasma levels of BNP and the BNP/ANP ratios in patients with IBAD were significantly higher than those in patients with LAF (both p < 0.01), but there was no significant difference in plasma levels of ANP. Regarding the clinical course of the patients with IBAD compared with those with LAF, the atrial volume increased gradually, and plasma levels of BNP were significantly higher. These findings suggested that IBAD was not only influenced by long-term atrial fibrillation, but also by subclinical left ventricular dysfunction.

Topics: Aged; Aged, 80 and over; Atrial Fibrillation; Atrial Natriuretic Factor; Dilatation, Pathologic; Female; Heart Atria; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Neurotransmitter Agents; Pulmonary Embolism; Ultrasonography

The hormonal response to percutaneous balloon mitral valvotomy (PBMV) has been described in patients in sinus rhythm (SR) and with atrial fibrillation (AF). The study aim was to evaluate the effect of hemodynamic parameters and PBMV on atrial natriuretic factor (ANF) secretion and plasma renin activity (PRA) in mitral stenosis in SR and AF.. Thirty-one patients (26 females, five males; mean age 50.5+/-14 years) with pure rheumatic mitral stenosis underwent PBMV. Fourteen patients had AF, and 17 were in SR. PRA and ANF were measured 24 h before, and at 30 and 60 min, 24 h and one month after PBMV, after resting in a supine position for > or =2 h. Digitalis and diuretics were withdrawn 48 h before sampling; neither had patients received ACE inhibitors or beta-blockers during the previous month.. PBMV was successful in all cases, without complication. Mitral valve area was increased and wedge pressure decreased in both groups after PBMV. In AF patients, neither PRA nor ANF were significantly affected before and after PBMV; in SR patients, ANF was decreased and PRA increased significantly, notably 24 h after PBMV. The cardiac index was increased in both groups, but was distinctly lower in AF patients both before and after PBMV.. Despite similar hemodynamic results, reversal of the hormonal pattern after PBMV occurred only in SR patients, most likely because in AF patients a low cardiac index elicits a hormonal response similar to heart failure. This abnormal hormonal pattern may limit functional recovery after PBMV; hence, PBMV is best attempted while patients are still in SR.

Topics: Adolescent; Adult; Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Catheterization; Echocardiography; Female; Hemodynamics; Humans; Male; Middle Aged; Mitral Valve Stenosis; Neurotransmitter Agents; Renin; Treatment Outcome; Ventricular Function, Left

Heart endocrine studies concerning patients with chronic atrial fibrillation (AF) have become increasingly important. Atrial natriuretic peptide (ANP) is released from atrial myocytes. The increased level of ANP in patients with AF is probably caused by the hemodynamic effect of the arrhythmia. The aim of this study was to explore plasma ANP levels in patients with chronic AF and to describe plasma ANP concentration changes following sinus rhythm (SR) restoration. The study group was comprised of 42 patients, aged between 43 and 76 years with chronic AF (more than 1 month) and a relatively controlled ventricular response (85.8+/-11.3 beats/min). Plasma ANP levels were measured before and 24 h after AF cardioversion. The control group comprised of 11 subjects. All had normal SR without history of AF and were compatible in age, sex and concomitant diseases with the examined group. ANP level values were expressed as mean+/-standard deviation. The mean plasma ANP level in the AF group was significantly higher than in the control group (59.5+/-15.6 vs. 34.3+/-10.2 pg/ml, P<0,001). Electrical or pharmacological cardioversion was performed in 42 patients. SR was successfully restored in 35 patients. Plasma ANP concentrations decreased significantly from baseline values (from 59.4+/-16.6 to 31.4+/-15.0 pg/ml, P<0.001) 24 h after cardioversion in the successful group, while they remained unchanged (60.2+/-10.7 to 59.4+/-10.4 pg/ml, NS) in patients with an unsuccessful cardioversion.. The mean concentration of ANP in patients with chronic AF was nearly two-times higher than in the control group with sinus rhythm. Conversion to SR was associated with a significant decrease and normalization in plasma ANP concentrations.

Topics: Adult; Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Chronic Disease; Echocardiography; Electric Countershock; Female; Follow-Up Studies; Heart Rate; Humans; Linear Models; Male; Middle Aged; Monitoring, Physiologic; Probability; Prognosis; Prospective Studies; Reference Values; Sensitivity and Specificity; Treatment Outcome

Topics: Atrial Fibrillation; Atrial Natriuretic Factor; Heart Failure; Humans; Protective Agents; Time Factors

Cilostazol, an antithrombotic agent, directly and indirectly increases the heart rate. This study investigated whether cilostazol increases the heart rate, and whether it has chronotropic effects on cardiac failure in patients with bradycardiac atrial fibrillation.. Twelve patients (6 males and 6 females) with bradycardiac atrial fibrillation underwent Holter monitoring (24-hour total heartbeat counts and frequency of pause), echocardiography (left ventricular end-diastolic diameter, percentage fractional shortening), chest roentgenography (cardiothoracic ratio), and measurements of brain natriuretic peptide and atrial natriuretic peptide before and 6 months after daily oral administration of 100-200 mg cilostazol.. Cilostazol administration increased the 24-hour total heartbeat counts from 69,685 +/- 1,690 (mean +/- SE; mean heart rate: 48 beats/min) to 87,352 +/- 3,123 (60), and decreased the frequency of pause from 362.3 +/- 72.9 to 112.3 +/- 41.0. Cardiothoracic ratio decreased from 55.8 +/- 1.1% to 52.5 +/- 1.1%, left ventricular end-diastolic diameter from 56.1 +/- 0.9 to 52.9 +/- 0.8 mm, but percentage fractional shortening was not significantly changed (from 33.0 +/- 2.2% to 33.7 +/- 2.1%). Brain natriuretic peptide decreased from 97.9 +/- 20.5 to 33.5 +/- 4.8 pg/ml, and atrial natriuretic peptide from 69.5 +/- 12.1 to 46.7 +/- 8.3 pg/ml.. Cilostazol has beneficial effects in patients with bradycardiac atrial fibrillation. The increase of heart rate may be mediated by improvement of conductivity in the atrioventricular node and increase of coronary blood supply caused by dilation of vessels.

Topics: Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Blood Pressure; Bradycardia; Cilostazol; Drug Administration Schedule; Female; Fibrinolytic Agents; Heart Rate; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Tetrazoles

Topics: Adult; Animals; Atrial Fibrillation; Atrial Natriuretic Factor; Cardiomyopathy, Dilated; Cause of Death; Death, Sudden, Cardiac; Disease-Free Survival; Female; Heart Failure; Humans; Male; Middle Aged; Predictive Value of Tests; Prognosis; Risk Factors

The predictive value of plasma atrial natriuretic peptide (ANP) on the cardioversion outcome was evaluated in 46 hospitalized patients with recent-onset atrial fibrillation (AF). Cardioversion was successful in 42 (91%) patients, 7 (15%) of them regained sinus rhythm spontaneously. After 12 months, 14 (33%) cardioverted patients were in chronic AF. There were no differences in plasma ANP levels between groups where cardioversion failed, those who cardioverted but later developed chronic AF or those who remained in sinus rhythm. However, among patients who were on antiarrhythmic therapy, ANP levels obtained after cardioversion were lower in those who later remained in sinus rhythm. We conclude that lower ANP after cardioversion may be associated with increased chances of long-term preservation of sinus rhythm.

Topics: Adult; Aged; Aged, 80 and over; Atrial Fibrillation; Atrial Natriuretic Factor; Electric Countershock; Electrocardiography; Heart Diseases; Humans; Male; Middle Aged; Prospective Studies

Reduced levels of atrial natriuretic peptide (ANP) has been suggested as a cause of fluid retention after combined Maze and valvular surgery. This study aimed to assess hormonal activation in the perioperative setting of isolated Maze procedures.. Changes in ANP, brain natriuretic peptide (BNP), antidiuretic hormone (ADH), aldosterone, and angiotensin II were measured in 16 patients (mean age 53+/-9 years) without concomitant heart disease undergoing the Maze (III) procedure. Ten matched patients (mean age 56+/-9 years) undergoing multivessel coronary artery bypass grafting served as controls. Measurements with hemodynamic correlates were obtained at baseline and after ventricular pacing (100 stimulations/minute), directly preoperatively, postoperatively and the first postoperative day. Weight gain and diuretic requirements were recorded.. The major differences in hormonal response were significantly higher plasma levels of ADH (Maze preoperative 1.1+/-0.4, postoperative 24.9+/-16.7 pmol/L; controls preoperative 1.1+/-0.1, postoperative 3.7+/-3.5 pmol/L) and aldosterone (Maze preoperative 106+/-94, postoperative 678+/-343 pmol/L; controls preoperative 124+/-79, postoperative 171+/-93 pmol/L) in the Maze group on the first postoperative day (p < 0.001). Preoperative baseline plasma levels of ANP and pulmonary capillary wedge pressures (PCWP) were higher in the Maze group but this difference was abolished by pacing, and postoperatively, ANP levels changed in parallel to the PCWP in both groups. Diuretic requirements were significantly higher in the Maze group.. Substantial increases in ADH and aldosterone were observed after the Maze procedure, indicating these hormones as important determinants in postoperative fluid retention. The role for ANP in this setting may be a less prominent than previously reported.

Topics: Adult; Aged; Aldosterone; Angiotensin II; Atrial Fibrillation; Atrial Natriuretic Factor; Coronary Artery Bypass; Female; Heart Atria; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Postoperative Complications; Vasopressins; Water-Electrolyte Balance

The purpose of this study was to assess whether transthoracic Doppler echocardiography and serum natriuretic peptide levels could predict mean pulmonary capillary wedge pressure (PCWP) in patients with chronic atrial fibrillation. We examined mitral flow velocity and pulmonary venous flow (PVF) velocity patterns in 32 patients with chronic atrial fibrillation. Plasma A-type and B-type natriuretic peptide (ANP, BNP, respectively) levels in the peripheral vein were measured. Significant correlations were observed between mean PCWP and the following: peak velocity (r = 0.51) and deceleration time (r = -0.65) of the mitral flow; peak velocity (r = 0.64) and deceleration time (r = -0.80) of the PVF; BNP (r = 0.60); and ANP (r = 0.36). Stepwise multiple linear regression analysis selected PVF deceleration time and mitral flow deceleration time as independent predictors of PCWP. A cutoff value of PVF deceleration time of < or =150 ms and a mitral flow deceleration time of < or =100 ms predicted a mean PCWP of > or =18 mm Hg, with a sensitivity of 100% and 80% and a specificity of 96% and 85%, respectively. In conclusion, PVF deceleration time and mitral flow deceleration time obtained from transthoracic Doppler echocardiography are more accurate predictors of mean PCWP than values obtained with natriuretic peptides in patients with chronic atrial fibrillation.

Topics: Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Chronic Disease; Echocardiography, Doppler; Female; Humans; Male; Middle Aged; Mitral Valve; Pulmonary Valve; Pulmonary Wedge Pressure; Regional Blood Flow; Regression Analysis

Atrial transport and atrial natriuretic peptide secretion is severely reduced from normal after the maze III procedure. To improve these factors, we developed a bilateral appendage-preserving maze procedure (BAP-maze).. Forty-six patients with chronic atrial fibrillation who underwent the BAP-maze procedure were compared with 40 patients who underwent the maze III procedure. The ratio of the peak velocity of the A and E waves of transmitral flow (transthoracic pulsed Doppler echocardiography), the left atrial appendage ejection fraction (transesophageal echocardiography), and the atrial natriuretic peptide secretory reserve during treadmill exercise test were measured at 6 months postoperatively.. Sinus rhythm was restored in 44 patients (95.7%) by the BAP-maze procedure and in 39 patients (97.5%) by the maze III procedure. The ratio of the peak velocity of the A and E waves was 0.52 +/- 0.22 in the BAP-maze group and 0.25 +/- 0.19 in the maze III group (p < 0.0001). The left atrial appendage ejection fraction was 44.7% +/- 11.5%, and the atrial natriuretic peptide secretory reserve was greater in the BAP maze group (p = 0.037).. The BAP-maze procedure improved atrial transport and atrial natriuretic peptide secretion as well as simplifying the maze operation, without decreasing its effectiveness against atrial fibrillation.

Topics: Aged; Atrial Fibrillation; Atrial Function; Atrial Natriuretic Factor; Cardiac Surgical Procedures; Chronic Disease; Female; Follow-Up Studies; Humans; Male; Middle Aged; Postoperative Complications

It is well established that rapid atrial rates, as in atrial fibrillation (AF), cause atrial electrical and structural remodeling leading to the maintenance of AF. The role of neurohumoral changes in this pathophysiologic vicious circle remains unclear.. We followed the concentrations of angiotensin II (AT II) and atrial natriuretic peptide (ANP) in a sheep model of AF. The sheep were atrially paced at 600 beats/min for 15 weeks. Electrophysiologic study was performed at regular intervals, and venous blood samples were taken. There was a slow increase in the vulnerability for AF. The cumulative incidence of sustained AF was 80% after 15 weeks of pacing. This increased vulnerability for AF was accompanied by atrial electrical remodeling and an increase in atrial pressure. AT II increased rapidly and stayed elevated: 17+/-4 pg/mL at baseline, and 40+/-11 and 39+/-7 pg/mL after 1 and 12 weeks of pacing, respectively. ANP rose more progressively: 35+/-7 pg/mL at baseline, and 72+/-17, 95+/-10, and 106+/-23 pg/mL after 1, 3, and 12 weeks, respectively. ANP levels correlated with atrial pressure and inducibility of AF. There was no relation between these parameters and AT II levels.. AT II and ANP increased significantly in this animal model of AF. Elevation of AT II occurs early and seems to be dependent on rapid atrial rate rather than the presence of AF. ANP increased more progressively. It paralleled the inducibility of AF and atrial stretch. Both neurohumoral pathways may form a potential therapeutic target for treatment of patients with AF.

Topics: Angiotensin II; Animals; Atrial Fibrillation; Atrial Function; Atrial Natriuretic Factor; Blood Pressure; Electrophysiologic Techniques, Cardiac; Female; Follow-Up Studies; Heart Atria; Models, Animal; Sheep

We sought to prospectively determine whether patients with congestive heart failure (CHF) at risk for paroxysmal atrial fibrillation (PAF) could be identified by clinical and study variables including the P-wave signal-averaged electrocardiogram (P-SAECG).. Although it is important to assess the risk of developing PAF in patients with CHF, it still remains difficult to predict the PAF appearance in patients with CHF clinically.. The study group consisted of 75 patients in sinus rhythm without a history of PAF, whose left ventricular ejection fraction, as measured by radionuclide angiography, was <40%. These patients underwent P-SAECG, echocardiography and 24-h Holter monitoring; in addition, the plasma concentration of atrial natriuretic peptide (ANP) was measured at study entry.. An abnormal P-SAECG was found at study entry in 29 of 75 patients. In the follow-up period of 21 +/- 9 months, the PAF attacks documented on the ECG significantly more frequently occurred in patients with (32%) rather than without an abnormal P-SAECG (2%) (p = 0.0002). The plasma ANP level was significantly higher in patients with rather than without PAF attacks (75 +/- 41 vs. 54 +/- 60 pg/ml, p = 0.01), although there were no significant differences in age, left atrial dimension or high grade atrial premature beats between the groups. The multivariate Cox analysis identified that the variables significantly associated with PAF development were an abnormal P-SAECG (hazard ratio 19.1, p = 0.0069) and elevated ANP level > or =60 pg/ml (hazard ratio 8.6, p = 0.018).. An abnormal P-SAECG and elevated ANP level could be predictors of PAF development in patients with CHF.

Topics: Adult; Aged; Aged, 80 and over; Atrial Fibrillation; Atrial Natriuretic Factor; Chromatography, High Pressure Liquid; Echocardiography; Electrocardiography, Ambulatory; Female; Heart Failure; Heart Rate; Humans; Male; Middle Aged; Prognosis; Proportional Hazards Models; Prospective Studies; Radionuclide Ventriculography; Stroke Volume; Tachycardia, Paroxysmal

The present study was conducted to determine whether preservation of the right atrial appendage lessens the decrease of plasma atrial natriuretic peptide levels after the maze procedure and whether the increase of plasma atrial natriuretic peptides improves the ability of the kidneys to excrete the fluid load after the operation.. We evaluated 42 patients who underwent the maze procedure. The right atrial appendage was preserved in 22 patients but not in 20. Blood samples were obtained before and after the operation for measurement of atrial natriuretic peptides. To evaluate the influence of atrial natriuretic peptides on the ability of the kidneys, we also measured body weight, fluid balance, and the doses of furosemide and dopamine administered after the operation.. The restoration to sinus rhythm at 1 month after was comparable in the two groups. Plasma atrial natriuretic peptide levels significantly increased after the operation in patients in whom the right atrial appendage was preserved (1 day after: 23.4 +/- 17.8 vs 3 days after: 42.7 +/- 23.6 and 7 days after: 36.3 +/- 23.7 pg/mL, P <.05) but not in patients in whom the right atrial appendage was not preserved (1 day after: 20.0 +/- 19.6, 3 days after: 28.5 +/- 19.3, and 7 days after: 23.0 +/- 16.1 pg/mL). Furthermore, plasma atrial natriuretic peptide levels were significantly lower in patients in whom the right atrial appendage was not preserved than in patients in whom the right atrial appendage was preserved at 3 and 7 days after the operation. The fluid balance during the first 7 days of the postoperative period was comparable in the two groups, although the total dose of dopamine used in the same period was significantly smaller in patients in whom the right atrial appendage was preserved than in patients in whom the right atrial appendage was not preserved (155.3 +/- 119.0 vs 244.9 +/- 129.0 microg/kg, P <.05).. The present study showed that preservation of the right atrial appendage lessens the decrease of plasma atrial natriuretic peptide levels after the maze procedure and that increased plasma atrial natriuretic peptides may improve the ability of the kidneys to excrete the fluid load after the operation.

Topics: Atrial Appendage; Atrial Fibrillation; Atrial Natriuretic Factor; Body Weight; Cardiac Surgical Procedures; Cardiotonic Agents; Diuretics; Dopamine; Female; Furosemide; Humans; Kidney; Male; Middle Aged; Urine; Water-Electrolyte Balance

The objective was to determine the independent association between atrial fibrillation (A-Fib) and activation of natriuretic peptides.. The association of A-Fib with activation of N-terminal atrial and brain natriuretic peptides (N-ANPs and BNPs, respectively) is uncertain but of great importance for the diagnostic utilization of natriuretic peptides. This uncertainty is related to the lack of appropriate controls, with left ventricular (LV) and atrial overload similar to A-Fib.. We prospectively measured N-terminal atrial and BNPs and endothelin-1 levels in 100 patients and 14 age- and gender-matched control subjects. The 32 patients with A-Fib were compared with 68 patients in sinus rhythm and similar LV and atrial overload (due to mitral regurgitation or LV dysfunction) measured simultaneously with hormonal levels with comprehensive Doppler echocardiography.. Patients with A-Fib compared with those in sinus rhythm had similar symptoms, comorbid conditions, cardioactive medications, pulmonary pressure, left atrial volume, and LV ejection fraction and filling characteristics but demonstrated higher N-ANP levels (2,613 +/- 1,681 vs. 1,654 +/- 1,323 pg/ml, p = 0.007) even after adjustment for the underlying cardiac disease (p < 0.0001). Conversely, BNP levels were similar in both groups (165 +/- 163 vs. 160 +/- 269 pg/ml, p = 0.9). In multivariate analysis, a higher N-ANP level was associated with A-Fib (p = 0.0003), symptom class (p < 0.0001) and endothelin-1 level (p = 0.032) independently of left atrial volume and LV ejection fraction. Conversely, BNP showed no independent association with and was most strongly associated with LV ejection fraction (p < 0.0001).. Atrial fibrillation is an independent determinant of higher N-ANP levels and blurs its association with LV dysfunction. Conversely, the BNP is not independently associated with A-Fib and is strongly determined by LV dysfunction, for which it is an independent marker.

Topics: Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Case-Control Studies; Chronic Disease; Echocardiography, Doppler; Endothelin-1; Female; Humans; Male; Multivariate Analysis; Natriuretic Peptide, Brain; Prospective Studies; Protein Precursors; Reproducibility of Results; Severity of Illness Index; Stroke Volume; Ventricular Dysfunction, Left

Electrical external cardioversion commonly used to treat atrial fibrillation (AF) is associated with myocardial membrane damage and disturbances in ionic homeostasis (hemodynamically unstable). The present study was designed to investigate whether alterations in ionic homeostasis observed were due in part to changes in the myocardial activity of Na,K-ATPase.. AF was induced by pacing in ten anesthetized sheep divided into two groups. Group I (n = 4) received a single external countershock of 360 J after three episodes of AF lasting 10 minutes. Group II (n = 6) served as controls. Activity, responsiveness to ouabain, and membrane expression of catalytic alpha and beta subunits of Na,K-ATPase in sarcolemmal myocardial membrane fractions were investigated. Membrane fluidity and fatty acid composition, and plasma levels of atrial natriuretic factor (ANF) also were measured. One shock after episodes of AF significantly decreased ventricular Na,K-ATPase activity up to 50% (P < 0.001) without modification of atrial activity at the membrane level. Sites with low affinity to ouabain showed a fivefold lower affinity for ouabain in the cardioversion group than in the control group (IC50 = 7.9 micromol/L vs 40 micromol/L ouabain, P < 0.05). Plasma levels of ANF were significantly increased in the cardioversion group compared with the control group. These changes were independent of membrane modulation in terms of expression of Na,K-ATPase, membrane fluidity, and fatty acid composition.. This study suggests that left ventricular perturbation of ionic homeostasis subsequent to transthoracic cardioversion could result from inactivation of Na,K-ATPase activity.

Topics: Animals; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Blotting, Western; Cardiac Pacing, Artificial; Disease Models, Animal; Electric Countershock; Electrophoresis, Polyacrylamide Gel; Enzyme Inhibitors; Fatty Acids; Ion Transport; Membrane Fluidity; Microsomes; Myocardium; Ouabain; Sarcolemma; Sheep; Sodium-Potassium-Exchanging ATPase

Topics: Anti-Arrhythmia Agents; Atrial Fibrillation; Atrial Natriuretic Factor; Cardiovascular Agents; Clinical Trials as Topic; Dose-Response Relationship, Drug; Female; Heart Failure; Humans; Phenethylamines; Potassium Channel Blockers; Sulfonamides; Therapeutic Equivalency

Plasma brain natriuretic polypeptide (BNP) levels have been used as biochemical markers of systolic left ventricular (LV) dysfunction. Although in vitro studies have shown the existence of BNP messenger RNA in the atria, the main production site of BNP is believed to be the ventricle. The hypothesis that the atrium could be a source of BNP was examined in patients with lone atrial fibrillation (AF), the most common type of sustained arrhythmia.. We studied 16 controls and 21 patients with lone AF. Plasma samples for BNP were selectively and serially obtained from the aorta, anterior interventricular vein (AIV), and coronary sinus (CS). Atrial natriuretic polypeptide (ANP) levels were also measured to determine whether the CS samples contained significant amounts of atrial venous drainage. Of the 3 sample locations, the CS had the greatest ANP levels, confirming transcatheter sampling position accuracy. BNP levels were significantly greater in the CS than AIV in the patients with AF (279 +/- 226 v 126 +/- 97 pg/mL; P < .01). Consequently, plasma BNP levels were also greater in the patients with AF than controls (103 +/- 90 v 5 +/- 2 pg/mL; P < .001). LV ejection fraction was significantly less in patients with AF than control patients. Atrial production of BNP decreased significantly after successful DC cardioversion of AF in the 5 restudied patients (182 +/- 139 v 59 +/- 64 pg/mL; P < .05).. The data suggest that AF is a condition in which BNP is produced in the atrium itself.

Topics: Adult; Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Cardiac Catheterization; Electric Countershock; Electrocardiography; Female; Heart Atria; Heart Rate; Humans; Middle Aged; Natriuretic Peptide, Brain; Radioimmunoassay; Stroke Volume

The present study was designed to determine clinical, hormonal, and echocardiographic factors influencing spontaneous conversion to sinus rhythm of recent-onset atrial fibrillation (symptoms <6 hours). The most important predictor of spontaneous conversion was the time of onset of atrial fibrillation; patients who developed the arrhythmia during sleep had the highest probability of spontaneous conversion during the first 24 hours. A second predictor was the plasma concentration of atrial natriuretic peptide during the arrhythmia.

Topics: Adult; Aged; Atrial Fibrillation; Atrial Function, Left; Atrial Natriuretic Factor; Circadian Rhythm; Echocardiography; Echocardiography, Doppler, Color; Electric Countershock; Female; Humans; Male; Middle Aged; Prognosis; Remission, Spontaneous

We designed this study to evaluate the relationship between plasma atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) levels and recurrence of atrial fibrillation (AF) after direct current cardioversion (DC) and the differences with aging. Fifty patients with mild congestive heart failure (CHF) undergoing elective DC of AF were included in this study (New York Heart Association (NYHA) functional class II: n = 42, III = 8). Patients who failed to show restoration of sinus rhythm or those with mitral valve stenosis were excluded. Before successful DC, we measured plasma levels of ANP and BNP and evaluated left atrial dimension (LAD), left ventricular end-diastolic dimension (LVDd), and left ventricular ejection fraction (EF) by echocardiography. Twenty-one patients had recurrence of AF within 2 months after DC (average 9.05 days). We followed up the other 29 patients for 580.5 days. By Cox stepwise multivariate analysis, history of AF (p = 0.007), low plasma levels of ANP (p = 0.003), and high plasma levels of BNP (p = 0.0003) were found to be independent predictors of recurrent AF. High plasma BNP levels indicating ventricular dysfunction and low plasma ANP levels may be due to atrial histological change such as fibrosis. In these patients, plasma ratios of ANP and BNP (ANP/BNP) less than 0.43 were predictive factors for AF recurrence (sensitivity 70%, specificity 62%), especially in patients who were older than 70 years (sensitivity 100%, specificity 80%). Relatively low plasma ANP level compared to BNP is an independent risk factor of AF recurrence in patients with CHF, especially in elderly patients, suggesting that plasma cardiac natriuretic peptides are important biochemical markers of AF recurrence in elderly patients with CHF.

Topics: Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Female; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Recurrence; Sensitivity and Specificity

To determine changes in plasma brain natriuretic peptide (BNP) after direct current cardioversion (DC) and to evaluate the relationship between plasma atrial natriuretic peptide (ANP) and BNP and the recurrence of atrial fibrillation (AF) after DC in patients with mild congestive heart failure (CHF), plasma ANP and BNP were measured before and after DC in 71 patients with mild CHF and then followed. In 65 patients with successful DC, both ANP and BNP decreased 15 min after DC. Cox stepwise multivariate analysis among 14 variables such as age, history of AF, echocardiographic parameters, medication and ANP and BNP revealed that only low ANP (p=0.005) and high BNP before DC (p=0.0002) were independent predictors of recurrent AF. A ratio of ANP to BNP less than 0.44 was a significant risk factor for AF recurrence by Kaplan-Meier analysis (p=0.02). BNP began to decrease immediately after successful DC. High BNP and relatively low ANP compared with BNP were independent risk factors of AF recurrence in patients with mild CHF.

Topics: Adult; Aged; Aged, 80 and over; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Cyclic GMP; Electric Countershock; Female; Heart Failure; Humans; Male; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain; Recurrence

In a previous study we found that hemoconcentration, which was identified by an increase in hematocrit, occured during a paroxysm of atrial fibrillation. In the present study we investigated the changes in hematocrit from sinus rhythm to paroxysm in 10 patients who had multiple paroxysms of atrial fibrillation in order to assess the ranges of the changes in hematocrit among the paroxysms. In these patients hematocrit was measured simultaneously with electrocardiographic recording during 3 or more paroxysms and sinus rhythm just before each paroxysm. The changes in hematocrit varied among the paroxysms. The maximum increase in hematocrit in each patient ranged from 3.5 to 8.0 points with an average of 5.1 points. Such a distinct increase in hematocrit which abruptly develops with a paroxysm of atrial fibrillation may be a potential risk for thrombus formation.

Topics: Aged; Aged, 80 and over; Atrial Fibrillation; Atrial Natriuretic Factor; Erythrocyte Count; Female; Heart Rate; Hematocrit; Humans; Macromolecular Substances; Male; Middle Aged; Recurrence

Heart-rate (HR) variability is an important predictor of mortality in patients with heart disease. We examined the effects of cilostazol, a quinolinone derivative, on HR and HR variability in patients with chronic atrial fibrillation associated with bradycardia episodes.. Thirteen patients with chronic atrial fibrillation associated with bradycardia episodes (minimal HR <40/min and/or pauses, ie, episodes with an RR interval > 2.5 sec) received cilostazol (100 or 200 mg/day) orally for at least 2 months and 24-hour Holter electrocardiography was performed before and after the start of cilostazol administration.. Minimal HR was significantly increased, by an average of 14 beats/min (bpm), at 3.3 +/- 0.8 weeks (mean +/- SD) after the start of cilostazol treatment. The number of pauses was significantly decreased. As a consequence, mean HR was increased by an average of 18 bpm. Maximal HR was also increased by an average of 19 bpm. The circadian variation of the HR, determined by cosine fitting, was not changed by cilostazol treatment. The time-domain HR variabilities, ie, the SD of the mean RR interval and the SD of the 5-minute mean RR intervals, were also unchanged. New York Heart Association functional class was significantly improved and the plasma atrial natriuretic polypeptide level was significantly decreased after the initiation of cilostazol treatment.. Cilostazol improves the slow HR episodes associated with chronic atrial fibrillation and maintains the HR circadian variation and time-domain variability, indicating that cilostazol has therapeutic utility for the treatment of the slow HR associated with chronic atrial fibrillation.

Topics: Aged; Aged, 80 and over; Atrial Fibrillation; Atrial Natriuretic Factor; Bradycardia; Cilostazol; Circadian Rhythm; Electrocardiography, Ambulatory; Female; Heart Rate; Humans; Male; Middle Aged; Phosphodiesterase Inhibitors; Statistics, Nonparametric; Tetrazoles

Chronic atrial fibrillation (AF) is one of the main complications of sick sinus syndrome (SSS). As previously reported, plasma brain natriuretic peptide (BNP), reflects hemodynamic changes in different pacing modes, as does plasma atrial natriuretic peptide (ANP), so the present study investigated whether plasma BNP or ANP can predict chronic AF after single-chamber ventricular (VVI) pacemaker implantation in patients with SSS. Plasma ANP and BNP levels were measured before and 1-3 months after implantation in 99 SSS patients. Long-term follow-up was conducted with chronic AF as an endpoint. Chronic AF occurred in 19 patients during a mean follow-up of 5.1 years. Plasma ANP and BNP were significantly higher in the patients who developed chronic AF after implantation than in those who did not, despite similar ANP and BNP levels between the 2 groups before implantation. Post-implant high BNP and a history of paroxysmal AF were independent predictors of chronic AF by a multivariate Cox proportional hazards analysis. Plasma BNP can predict the development of chronic AF after VVI pacemaker implantation in patients with SSS because increased levels may reflect latent hemodynamic abnormalities, which may contribute to the development of AF after VVI pacemaker implantation.

Topics: Actuarial Analysis; Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Cardiac Pacing, Artificial; Chronic Disease; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Proportional Hazards Models; Sick Sinus Syndrome; Survival Rate

The antifibrillatory mechanism of biatrial (BI) pacing has not been fully elucidated. We investigated the role of a haemodynamic mechanism in eight patients implanted with a BI pacemaker (Chorus RM) by comparing changes in mitral Doppler flow and atrial and B-type natriuretic peptide levels (ANP, BNP) with BI pacing compared with sinus rhythm and right atrial (RA) pacing.. Measurements were taken after 60 min in the supine position in each of two pairs of randomized pacing modes: (a) AAI40 beats x min(-1), (allows sinus rhythm mean rate 56 beats x min(-1), SR) vs AAI 40 beats x min(-1) with synchronized left atrial pacing (SRSync); (b) overdrive AAI RA pacing (89 beats x min(-1) (n = 6) or 70 beats x min(-1) (n = 2)) vs overdrive AAI BI pacing. Within each pair there was significant earlier activation of the left atrial Doppler signal in relation to the surface ECG P wave with BI pacing (SR 163 +/- 10 ms vs SRSync 144 +/- 21 ms (P = 0.02), and RA 232 +/- 14 ms vs BI 196 +/- 16 ms (P = 0.001)), and significant shortening of the P-R interval (SR 163 +/- 29 ms vs SRSync 148 +/- 20 (P = 0.007) and RA 261 +/- 27 ms vs BI 232 +/- 23 (P = 0.001)). The net observed effect was of no change in the atrioventricular timing sequence (delay of peak E or A to QRS/ mitral valve closure) and no change in other Doppler echo parameters. Levels of the cardiac peptides ANP and BNP were raised compared with healthy controls, but did not significantly change during the study.. Acute BI pacing shortens the P-R interval and causes earlier left atrial contraction in relation to the surface electrocardiogram P wave. It does not alter the atrioventricular timing cycle, any other Doppler measurements or change cardiac peptide levels. This suggests that BI pacing does not cause haemodynamic changes that could account for any antifibrillatory properties.

Topics: Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Cardiac Pacing, Artificial; Electrocardiography; Female; Hemodynamics; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Pacemaker, Artificial

Circulating cardiac natriuretic peptides play an important role in maintaining volume homeostasis, especially during conditions affecting hemodynamics. During atrial fibrillation (AF), levels of plasma atrial natriuretic peptide (ANP) becomes elevated. The aim of this study was to gather information about gene expression of the natriuretic peptide system on the atrial level in patients with AF.. Right atrial appendages of 36 patients with either paroxysmal or persistent AF were compared with 36 case matched controls in sinus rhythm for mRNA expression of pro- atrial natriuretic peptide (pro-ANP), pro-brain natriuretic peptide (pro-BNP), and their natriuretic peptide receptor type-A (NPR-A). We investigated patients without (n = 36) and with (n = 36) valvular disease. Persistent AF was associated with higher mRNA expression of pro-BNP (+66%, P = 0.04, in patients without valvular disease, and +69%, P < 0.01, in patients with valvular disease) and lower mRNA expression of NPR-A (-58%, P = 0.02, in patients without valvular disease, and -62 %, P < 0.01, in patients with valvular disease). The mRNA content of pro-ANP was only increased in patients with valvular disease (+12%, P = 0.03). No changes were observed in patients with paroxysmal AF.. This study demonstrates that persistent, but not paroxysmal, AF induces alterations in gene expression of pro-BNP and NPR-A on the atrial level. Although AF generally is associated with an increase of plasma ANP level, a change in mRNA content of pro-ANP is only observed in the presence of concomitant valvular disease and is of minor magnitude.

Topics: Adult; Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Female; Heart Atria; Heart Valve Diseases; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Protein Precursors; Receptors, Atrial Natriuretic Factor; RNA, Messenger

Recently, combined treatment using the Maze procedure for organic heart disease and atrial fibrillation has been reported, but there have been few studies of cardiac rhythm after combined treatment. Predictors of cardiac rhythm after combined surgical treatment have been unknown.. Thirty patients who underwent cardiac surgery with the Maze procedure were retrospectively enrolled in this study. Two groups consisted of the patients with restoration of sinus rhythm after surgery (SR: n=15, 6 males and 9 females, mean age of 64 years), and the patients with maintenance of atrial fibrillation (AF; n=15, 5 males and 10 females, mean age of 61 years). Before cardiac surgery, all patients underwent exercise testing with measurement of atrial natriuretic peptide (ANP) before and after exercise testing, two-dimensional echocardiography, and right and left heart catheterization.. The mean maximal heart rate and the ANP level after exercise testing in SR were significantly higher than those in AF. The left atrial dimension and right atrial and pulmonary capillary wedge pressures were significantly higher in AF than in SR. These findings indicate that subjects in SR exhibited less impaired atrial function which were evaluated by exercise testing with measurement of ANP, echocardiography, and cardiac catheterization.. The atrial function of patients with sinus rhythm after the Maze procedure may be less impaired than that of patients remaining in atrial fibrillation.

Topics: Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Combined Modality Therapy; Electrocardiography; Exercise Test; Female; Heart Atria; Heart Septal Defects, Atrial; Hemodynamics; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Mitral Valve Stenosis; Postoperative Complications; Retrospective Studies; Suture Techniques; Treatment Outcome

The Cox maze procedure has been confirmed to be effective in curing atrial fibrillation. Some authors have reported severe fluid retention after the Cox maze procedure and have suggested decreased secretion of atrial natriuretic peptide as a possible mechanism. This study was designed (1) to examine the serial changes in atrial natriuretic peptide after the Cox maze procedure as compared with changes occurring after coronary artery bypass grafting and (2) to elucidate any differences in atrial natriuretic peptide levels between patients with transient recurrence of atrial fibrillation after the Cox maze procedure and those without recurrence of atrial fibrillation.. Blood samples were drawn from the right and left atria in patients undergoing the Cox maze procedure (n = 19) and from the right atrium in patients undergoing coronary artery bypass grafting (n = 6) before and 1, 2, and 3 days after the operation. In six patients undergoing the Cox maze procedure, samples were also drawn from the radial artery before and 1, 2, 3, 5, and 7 days after the operation. The plasma samples were prepared by refrigerated centrifugation and stored until radioimmunoassay. In the Cox maze procedure group, atrial natriuretic peptide levels in the right atrium were 629 +/- 366, 154 +/- 112, 162 +/- 112, and 183 +/- 97 pg/ml and those in the left atrium were 276 +/- 168, 152 +/- 91, 162 +/- 111, and 145 +/- 80 pg/ml before and 1, 2, and 3 days after the operation, respectively. A marked decrease in atrial natriuretic peptide levels was evident after the Cox maze procedure (p < 0.001). There was no significant correlation between atrial natriuretic peptide levels and atrial pressures after the Cox maze procedure, which suggests that secretion of atrial natriuretic peptide by the atria was impaired. There was a significant correlation between the atrial natriuretic peptide levels in the left atrium and those in the peripheral radial artery, and the decreased levels of atrial natriuretic peptide in the radial artery continued for 7 days after the Cox maze procedure. There were no differences in the atrial natriuretic peptide levels between the patients with transient recurrence of atrial fibrillation (n = 6) and those without recurrence (n = 13) after the Cox maze procedure. In the coronary artery bypass grafting group, the atrial natriuretic peptide levels in the right atrium were 115 +/- 37, 124 +/- 48, 154 +/- 54, and 156 +/- 36 pg/ml before and 1, 2, and 3 days after the operation, respectively. No change was seen after the operation.. We observed a significant decrease in atrial natriuretic peptide levels after the Cox maze procedure. This may be one of the possible causes of fluid retention after this procedure. These decreased atrial natriuretic peptide levels after the Cox maze procedure may result from the multiple atriotomy incisions and excision of both atrial auricles performed during the procedure, rather than from the conversion of atrial fibrillation to normal sinus rhythm.

Topics: Atrial Fibrillation; Atrial Function; Atrial Natriuretic Factor; Cardiac Surgical Procedures; Case-Control Studies; Coronary Artery Bypass; Female; Humans; Male; Middle Aged; Postoperative Complications; Radial Artery; Recurrence; Water-Electrolyte Imbalance

The aim of the present study was to assess whether cGMP release to ANP stimulation can be a biochemical marker of subsequent successful electrical cardioversion of lone atrial fibrillation to sinus rhythm. For this purpose, we studied 13 patients with chronic, lone atrial fibrillation of less than one year's duration who presented to our laboratory for electrical therapy of their arrhythmia. Prior to electrical cardioversion, peripheral venous cGMP levels were assessed at baseline and following an intravenous challenge of 50 Ug human ANP. Venous blood samples for cGMP assessment were taken a) at baseline, b) 5 and 10 mins after the end of ANP infusion. ANOVA of repeated measures was used for statistical analysis. Eight of the study patients were successfully cardioverted to sinus rhythm, while the remaining 5 were not. Although no difference was noted between the two groups regarding the mean time of arrhythmia duration as well as left atrial and ventricular dimensions, ANP stimulation provoked significantly greater cGMP release in patients whose arrhythmia reverted to sinus rhythm, when compared with that of patients whose arrhythmia persisted (p < 0.001). Therefore, cGMP levels following ANP challenge might discriminate between patients with chronic AF who are going to be successfully cardioverted and those who are not. These findings imply that the underlying atrial disease might be different in extent/nature between patients with lone AF responsive to cardioversion and those with resistant arrhythmia.

Topics: Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Case-Control Studies; Cyclic GMP; Electric Countershock; Female; Humans; Male; Middle Aged; Stimulation, Chemical; Time Factors

We investigated the effect of electrical cardioversion of atrial fibrillation in patients with heart failure. The study group consisted of 24 patients with mild to moderate heart failure [13 men, mean age 67+/-7 years, mean peak oxygen consumption (peak VO2) 16.3+/-2.8 ml/min/kg] and chronic atrial fibrillation (median duration 19 (1-228) months). Patients were stable on digoxin, diuretics, nitrates and angiotensin converting enzyme inhibitors; no prophylaxis with antiarrhythmics was started after cardioversion. Cardioversion was unsuccessful in 6 patients; of the 18 patients in whom sinus rhythm was obtained 9 had a relapse of atrial fibrillation within 6 weeks after cardioversion. The remaining 9 patients with maintenance of sinus rhythm and the 15 (6+9) patients with atrial fibrillation at follow-up after 6 weeks did not differ with respect to any baseline characteristic, including age, peak VO2, duration of atrial fibrillation, echocardiographic left ventricular and left atrial dimensions, plasma atrial natriuretic peptide and norepinephrine. In the patients with maintenance of sinus rhythm, baseline measurements were repeated at follow-up. Peak VO2 did not change significantly (16.7+/-2.8 to 17.6+/-3.3 ml/min/kg, P=0.29); also, echo parameters, atrial natriuretic peptide and norepinephrine were not significantly affected. These results indicate that it is difficult to achieve lasting sinus rhythm through electrical cardioversion in patients with atrial fibrillation and mild to moderate heart failure. Moreover, in patients with maintenance of sinus rhythm after cardioversion no significant benefit in terms of peak VO2, cardiac dimensions, and neurohumoral status is to be expected. Hence, indiscriminate cardioversion of atrial fibrillation in the setting of heart failure does not appear to be useful.

Topics: Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Echocardiography; Electric Countershock; Electrocardiography, Ambulatory; Exercise Test; Female; Follow-Up Studies; Heart Failure; Heart Rate; Humans; Male; Norepinephrine; Oxygen Consumption; Recurrence; Treatment Outcome

The purpose of this study was to analyze the determinants of atrial natriuretic peptide level in patients with congestive heart failure and atrial fibrillation. In particular, the duration of atrial fibrillation was analyzed because atrial fibrillation per se might have a specific effect on atrial natriuretic peptide level. The study group consisted of 26 patients with mild to moderate stable congestive heart failure and chronic atrial fibrillation. Plasma samples of atrial natriuretic peptide were obtained at rest and were analyzed with radioimmunoassay. Median atrial natriuretic peptide level was 213 (range 42 to 438) ng/L. Multivariate determinants of atrial natriuretic peptide level were use of calcium antagonists and the duration of atrial fibrillation; both factors showed an inverse relation with atrial natriuretic peptide level. The finding that atrial natriuretic peptide level was lower among patients with atrial fibrillation of longer duration suggests a form of insufficiency of the atria to produce atrial natriuretic peptide because of degenerative changes in the atria inherent to chronic atrial fibrillation.

Topics: Aged; Atrial Fibrillation; Atrial Function; Atrial Natriuretic Factor; Case-Control Studies; Female; Heart Failure; Humans; Male; Myocardium; Radioimmunoassay; Time Factors

Plasma atrial natriuretic peptide and endothelin are further elevated in patients with congestive heart failure and atrial fibrillation, compared to those with sinus rhythm. The higher plasma endothelin suggests that vasoconstriction is an important mechanism for hemodynamic compensation in these patients.

Topics: Aged; Aldosterone; Atrial Fibrillation; Atrial Natriuretic Factor; Catecholamines; Endothelins; Female; Heart Failure; Hormones; Humans; Male; Middle Aged; Randomized Controlled Trials as Topic; Renin; Vasoconstriction

One of the earliest recognized postoperative complications of the maze procedure was the fluid retention in the immediate postoperative period. Routine postoperative administration of diuretics markedly reduces the frequency and severity of the fluid retention. However, the cause of the abnormal fluid balance is still uncertain.. We evaluated 24 patients: 15 patients underwent the maze procedure (maze group) and 9 patients did not (nonmaze group). Blood samples were obtained before and in the time course after operation for atrial natriuretic peptide measurement. To evaluate the influence of atrial natriuretic peptide on the body fluid balance, we also measured the amount of body fluid balance and the total doses of furosemide and dopamine administered after operation. To examine the effect of the maze procedure on atrial natriuretic peptide secretion in chronic phase, we measured plasma atrial natriuretic peptide levels during dynamic exercise in 21 patients who had undergone cardiac operations 2 years before.. Plasma atrial natriuretic peptide levels in the nonmaze group significantly increased after operation. In contrast, plasma atrial natriuretic peptide levels in the maze group did not increase, and these levels were significantly lower than in the nonmaze group. Although significantly greater doses of furosemide and dopamine were administered to the maze group than to the nonmaze group, the body fluid balance in the maze group was comparable with that in the nonmaze group in the early postoperative period. The response of atrial natriuretic peptide secretion by exercise was significantly attenuated in the maze group (n = 12) compared with the nonmaze group (n = 9) even 2 years after surgery, although there were no significant differences in heart rate or blood pressure during exercise between two groups.. These results suggest that the maze procedure attenuates atrial natriuretic peptide secretion in the early postoperative period and persists in chronic phase. This attenuated atrial natriuretic peptide secretion may reduce the ability of the kidneys to handle fluid load early after surgery.

Topics: Atrial Fibrillation; Atrial Natriuretic Factor; Body Fluids; Cardiac Surgical Procedures; Chronic Disease; Diuretics; Dopamine; Exercise; Female; Follow-Up Studies; Furosemide; Heart Atria; Heart Rate; Humans; Male; Middle Aged; Postoperative Complications

Topics: Aged; Atrial Fibrillation; Atrial Function; Atrial Natriuretic Factor; Cardiac Surgical Procedures; Female; Heart Septal Defects, Atrial; Heart Valve Diseases; Humans; Male; Middle Aged; Postoperative Period

We studied plasma levels of atrial and brain natriuretic peptides at rest and after exercise before and after intracardiac surgery with and without the maze procedure in patients with chronic heart failure secondary to valvular heart disease. The present study found that an increased response of both cardiac natriuretic peptides is attenuated with resulting water retention after the maze procedure.

Topics: Atrial Fibrillation; Atrial Natriuretic Factor; Case-Control Studies; Exercise Test; Female; Follow-Up Studies; Heart Atria; Heart Failure; Heart Valve Diseases; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Nerve Tissue Proteins; Time Factors; Water-Electrolyte Balance

The mechanism for increased secretion of atrial natriuretic factor (ANF) during tachycardia and atrial fibrillation has remained unsettled. In seven open-chest pigs, the plasma concentration of ANF increased from 49.8 +/- 12.4 to 131.8 +/- 15.7 pg/ml when heart rate was increased from 133 +/- 13 to 212 +/- 4 beats/min by atrial pacing. Right atrial maximal diameter, recorded by ultrasonic technique at the maximal atrial filling, did not increase. During pacing tachycardia, the atrial contraction (a wave) occurs during atrial filling, and the a wave becomes superimposed on the v wave. In the present study the systolic atrial pressure (a wave) increased from 5.8 +/- 0.8 to 9.6 +/- 0.5 mmHg. The significance of this pressure rise was subsequently examined. After complete atrioventricular (AV) block, the AV delay was progressively increased, without altering heart rate, until the a wave was similar to the the a wave during the preceding tachycardia. Plasma ANF increased to 113.8 +/- 14.7 pg/ml, which showed that the increase in atrial pressure during atrial systole is a stimulus for ANF release. In the second part of the study, atrial fibrillation was induced in six open-chest pigs by rapid atrial pacing after complete AV block. Plasma ANF increased from 83.5 +/- 7.2 to 269.0 +/- 45.4 pg/ml during atrial fibrillation. No increase in atrial dimensions occurred during atrial fibrillation, but atrial pressure was substantially elevated. Thus, although passive atrial stretch stimulates ANF release during blood volume expansion, the present study shows that the increase in atrial pressure during atrial contraction is a stimulus for release of ANF during tachycardia and atrial fibrillation.

Topics: Animals; Atrial Fibrillation; Atrial Function; Atrial Natriuretic Factor; Atrioventricular Node; Blood Volume; Cardiac Pacing, Artificial; Female; Heart Rate; Hemodynamics; Male; Myocardial Contraction; Pressure; Swine; Systole; Time Factors

To ascertain whether atrial natriuretic peptides could be used as prospective and independent predictors of total mortality in an elderly population.. Atrial natriuretic peptides, ANP(1-98) and ANP(99-126), were measured in 541 subjects from the 85-year-old population of Gothenburg, Sweden. Before the study cardiovascular disorders such as congestive heart failure, ischaemic heart disease, hypertension and atrial fibrillation were defined. Total mortality was recorded during the prospective 60-month follow-up period.. Individuals aged 85 years from the population of Gothenburg, Sweden, were visited once at home and made one visit to Vasa Hospital.. Sixty-month mortality in relation to circulating concentrations of atrial natriuretic peptides.. Circulating concentrations of ANP(1-98) and ANP(99-126) were significantly correlated with 60-month mortality in the total study population (ANP(1-98), P < 0.001: ANP(99-126), P < 0.01). In subjects with cardiovascular disorders, 60-month mortality was significantly correlated with increased concentrations of ANP(1-98) (P < 0.01) and ANP(99-126) (P < 0.05). In subjects with no defined cardiovascular disorder, 60-month mortality was significantly correlated with increased ANP(1-98) concentrations (P < 0.01).. In the elderly population, atrial peptides predict mortality in subjects with defined cardiovascular disorders as well as in the total population and may predict future cardiovascular disorder.

Topics: Aged; Aged, 80 and over; Atrial Fibrillation; Atrial Natriuretic Factor; Heart Diseases; Heart Failure; Humans; Hypertension; Myocardial Ischemia; Survival Rate

Recently, we developed a goat model of chronic atrial fibrillation (AF). Due to AF, the atrial effective refractory period (AERP) shortened and its physiological rate adaptation inversed, whereas the rate and stability of AF increased. The goal of the present study was to evaluate the role of (1) the autonomic nervous system, (2) ischemia, (3) stretch, (4) atrial natriuretic factor (ANF), and (5) rapid atrial pacing in this process of electrical remodeling.. Twenty-five goats were chronically instrumented with multiple epicardial atrial electrodes. Infusion of atropine (1.0 mg/kg; n=6) or propranolol (0.6 mg/kg; n=6) did not abolish the AF-induced shortening of AERP or interval (AFI). Blockade of K+(ATP) channels by glibenclamide (10 micromol/kg; n=6) slightly increased the AFI from 95+/-4 to 101+/-5 ms, but AFI remained considerably shorter than during acute AF (145 ms). Glibenclamide had no significant effect on AERP after electrical cardioversion of AF (69+/-14 versus 75+/-15 ms). Volume loading by 0.5 to 1.0 L of Hemaccel (n=12) did not shorten AERP. The median plasma level of ANF increased from 42 to 99 pg/mL after 1 to 4 weeks of AF (n=6), but ANF infusion (0.1 to 3.1 microg/min, n=4) did not shorten AERP. Rapid atrial pacing (24 to 48 hours; n=10) progressively shortened AERP from 134+/-10 to 105+/-6 ms and inversed its physiological rate adaptation.. Electrical remodeling by AF is not mediated by changes in autonomic tone, ischemia, stretch, or ANF. The high rate of electrical activation itself provides the stimulus for the AF-induced changes in AERP.

Topics: Animals; Anti-Arrhythmia Agents; Atrial Fibrillation; Atrial Function; Atrial Natriuretic Factor; Atropine; Cardiac Pacing, Artificial; Dilatation; Electrophysiology; Glyburide; Goats; Heart; Myocardial Ischemia; Neurotransmitter Agents; Physical Stimulation; Propranolol; Refractory Period, Electrophysiological

The aim of this study was to evaluate clinical, adrenergic and endocrine factors that could predict sinus rhythm maintenance after direct current cardioversion in chronic atrial fibrillation. Nineteen patients with chronic non-rheumatic atrial fibrillation (mean duration 6 +/- 5 months) were studied. They were exercised 24 h before cardioversion at maximum effort with the Naughton protocol. Heart rate and blood pressure at rest and exercise were recorded and blood samples were taken for the assessment of adrenergic activity, by measuring cyclic adenosine monophosphate, heart endocrine function, atrial natriuretic peptide and its second messenger, cyclic guanosine monophosphate. Fifteen of the 19 patients were initially converted to sinus rhythm (eight patients with external and seven patients with internal DC shocks). After 3 months eight patients remained in sinus rhythm and 11 had relapsed, most of them within the first month. On exercise the chronotropic response was lower in the group who remained in sinus rhythm than in the group in atrial fibrillation (peak heart rate 147 +/- 11 beats.min-1 vs 165 +/- 24 beats.min-1 P = 0.02). During exercise, the systolic blood pressure in the sinus group reached higher values than in the group who relapsed (192 +/- 17 mmHg vs 176 +/- 18 mmHg, P = 0.03). Cyclic adenosine monophosphate increased significantly from rest to peak exercise in the sinus rhythm group (from 23 +/- 9 pmol.ml-1 to 31 +/- 15 mol.ml-1, P = 0.02) while it remained unchanged in the atrial fibrillation group (25 +/- 10 pmol.ml-1 to 24 +/- 8 pmol.ml-1, P = 0.02). For all 19 patients the difference in cyclic adenosine monophosphate between rest and exercise was negatively correlated with maximum heart rate (r = 0.58, P = 0.009). Atrial natriuretic peptide increased from rest to peak exercise in the sinus rhythm group (from 129 +/- 58 fmol.ml-1 to 140 +/- 66 fmol.ml-1) while it remained unchanged in the group in which atrial fibrillation persisted or recurred (from 112 +/- 58 fmol.ml-1 to 111 +/- 53 fmol.ml-1, P = 0.002). A significant correlation between atrial natriuretic peptide and cyclic guanosine monophosphate levels at exercise before cardioversion was found for the sinus rhythm group only (r = 0.76, P = 0.02). In patients with non-rheumatic chronic atrial fibrillation evaluation of clinical parameters such as heart rate and blood pressure changes during maximal exercise can be useful in the choice of suitable therapy. An inadequate increase

Topics: Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Blood Pressure; Chronic Disease; Cyclic AMP; Cyclic GMP; Discriminant Analysis; Electric Countershock; Exercise Test; Female; Heart Rate; Humans; Male; Middle Aged; Prognosis; Treatment Outcome

The response of atrial natriuretic peptide (ANP) release to haemodynamic influences after cardioversion of atrial fibrillation has not been fully examined. We measured plasma concentrations of ANP and assessed haemodynamic changes 60-120 min after DC cardioversion in 22 patients with non-valvular chronic atrial fibrillation. Passive leg elevation to enhance volume expansion was performed 60 min after DC cardioversion. Sinus rhythm was restored in 18 of the 22 patients (successful DC cardioversion group). The control group consisted of seven patients with non-valvular chronic atrial fibrillation who did not undergo DC cardioversion (atrial fibrillation control group). In the successful DC cardioversion group, the mean pulmonary artery wedge pressure decreased significantly 15 min after cardioversion (P < 0.05) and then remained unchanged. Plasma concentrations of ANP also decreased significantly 15 min after cardioversion (P < 0.05). Furthermore, there was an additional significant decrease in ANP levels for up to 60 min after cardioversion (P < 0.05 from 15 min). Passive leg elevation for 15 min led to an increase in the mean pulmonary artery wedge pressure (P < 0.01) and right atrial pressure (P < 0.05), but did not result in increased plasma concentrations of ANP (47.1 +/- 27.6 vs 43.9 +/- 34.4 pg.ml-1, mean +/- SD, P = ns). In the atrial fibrillation control group, passive leg elevation increased the mean pulmonary artery wedge pressure (P < 0.01), the mean right atrial pressure (P < 0.05) and plasma concentrations of ANP (139.9 +/- 85.8 vs 168.1 +/- 108.2, P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Cardiac Output; Chronic Disease; Cyclic GMP; Electric Countershock; Female; Hemodynamics; Humans; Male; Middle Aged; Pulmonary Wedge Pressure; Treatment Outcome

The aim of the present study was to determine whether the level of plasma atrial natriuretic peptide (ANP), an indicator of atrial stretching, correlates with the formation of a thrombus in the left atrium during cardioembolic stroke with atrial fibrillation. Plasma concentrations of immunoreactive ANP and thrombin-antithrombin III complex (TAT) were measured in five age-matched groups including: 16 patients with acute cardioembolic stroke and atrial fibrillation (group 1), 26 patients with chronic cardioembolic stroke and atrial fibrillation (group 2), 27 patients with atrial fibrillation without previous stroke (group 3), 21 patients with acute lacunar stroke (group 4), and 27 healthy controls. The plasma ANP levels were higher in group 1, regardless of the stage, than those estimated at chronic stage in group 4 and in healthy controls. There were no stage-related differences between groups 1, 2 and 3. Plasma levels of ANP in group 2, a high risk group of cardioembolic stroke, were higher than in group 3, a low risk group. There was no correlation between plasma levels of ANP and mean blood pressure, pulse rate or plasma levels of TAT in any group. These results indicate that the determination of plasma ANP concentration is useful to distinguish a high risk patient from a low risk patient and also a cardioembolic stroke patient from a lacunar stroke patient. They also underscore the difficulties in recognizing left atrial thrombus formation by determining the plasma ANP concentration in cardioembolic stroke.

Topics: Aged; Aged, 80 and over; Atrial Fibrillation; Atrial Natriuretic Factor; Case-Control Studies; Heart Diseases; Humans; Intracranial Embolism and Thrombosis; Male; Middle Aged

Aim of the study was to assess possible differences in ANP levels between patients with congestive heart failure (CHF) with and without chronic atrial fibrillation (AF). We studied 12 patients with chronic AF and 17 patients with sinus rhythm (SR), (m 16, f 13, years 67.7 +/- 8.6), with CHF, not hypertensive, without valvular or congenital heart disease, NYHA class II-III, by ANP RIA and echocardiography. Left atrial (LA/m2) dimensions were significantly higher in patients with AF, and ANP was also more increased in AF. Significant linear correlations between heart rate and ANP, ANP and LV shortening fraction and ANP and A/E ratio, assessed by Doppler trans-mitral flow, were observed in SR but not in AF patients. A significant correlation between ANP and left ventricular mass g/m2 was observed only in AF. Higher ANP levels seem associated with left ventricular enlargement, assessed as left ventricular mass, in AF patients; in SR patients, higher ANP levels are associated with depressed systolic function and with decreased left ventricular compliance. Rate dependent ANP incretion seems blunted in chronic AF; neurogenic heart rate control and/or coordinated atrial systoles may be ANP modulators in sinus rhythm CHF.

Topics: Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Female; Heart Failure; Humans; Male; Middle Aged; Regression Analysis

Plasma immunoreactive atrial natriuretic peptide (ANP) and cyclic guanosine monophosphate (cGMP), serum thyroxine (T4), triiodothyronine (T3), and thyrotropin (TSH) concentrations were measured in 11 patients with thyrotoxicosis and atrial fibrillation (group 1), in 5 patients with thyrotoxicosis and sinus cardiac rhythm (group 2) and in 8 healthy subjects in comparable age. Patients with thyrotoxicosis were studied before and after treatment with methimazole (3 x 20 mg daily) during 10 days. During treatment sinus cardiac rhythm returned in 6 patients with initial fibrillation (group 1a) while 5 patients still presented atrial fibrillation at the end of the study (group 1b). All patients from group 2 maintained a sinus cardiac rhythm throughout the study. Median plasma concentrations of ANP and cGMP before treatment in patients from group 1 were higher: 43.8 pmol/l and 11.0 nmol/l, respectively than in patients from group 2: 20.0 pmol/l (p < 0.005) and 6.5 nmol/l (p < 0.01), respectively. In all groups of patients methimazole treatment resulted in a significant decrease of plasma ANP and cGMP concentrations in parallel to a reduction of serum T3 and T4 levels. After therapy, plasma ANP and cGMP levels in patients from group 1a were not significantly different from those in patients from group 2, while in patients from group 1b remained slightly elevated. Presented results suggest that atrial fibrillation in patients with thyrotoxicosis represents an important factor augmenting plasma ANP and cGMP levels, in addition to the stimulatory effect exerted by thyroid hormones. However, the marked reduction of serum thyroid hormones produced by short-term methimazole treatment in patients with thyrotoxicosis was associated with parallel decrease of plasma ANP and cGMP levels toward normal values. Therefore, the influence of thyroid hormones on plasma ANP and cGMP concentrations seems relatively more important than the effect of atrial fibrillation.

Topics: Adult; Atrial Fibrillation; Atrial Natriuretic Factor; Cyclic GMP; Female; Humans; Methimazole; Middle Aged; Thyroid Hormones; Thyrotoxicosis

Topics: Adult; Atrial Fibrillation; Atrial Natriuretic Factor; Biopsy; Cardiomyopathies; Chronic Disease; Female; Heart Ventricles; Humans; Immunohistochemistry; Male; Middle Aged; Tachycardia

The purpose of this study was to evaluate the effect of direct current cardioversion therapy on the plasma concentration of atrial natriuretic peptide and to determine the main factors that influence the change in plasma atrial natriuretic peptide levels in patients with atrial fibrillation.. In atrial arrythmias, whether the fast atrial rate itself or the associated elevation of atrial pressure, or both, contributes to the increase in atrial natriuretic peptide is a subject of debate.. In 15 patients with mild mitral stenosis, plasma atrial natriuretic peptide levels were measured and transmitral flow pattern was obtained by continuous wave Doppler echocardiography immediately before cardioversion and at 5 min, 4 h, 24 h and 5 days after direct current cardioversion. Mean mitral pressure gradient and atrial filling fraction were calculated on the basis of transmitral flow.. In three patients who did not have a successful return to sinus rhythm, plasma atrial natriuretic peptide levels remained elevated after cardioversion. In 12 patients who maintained sinus rhythm, plasma atrial natriuretic peptide levels were significantly reduced from 79 +/- 29 to 36 +/- 11 pg/ml 4 h after cardioversion to sinus rhythm. However, the mitral pressure gradient did not change significantly during the observation period. There were progressive increases in atrial filling fraction throughout the observation period. From 4 h to 5 days after direct current cardioversion, plasma atrial natriuretic peptide levels gradually increased concomitantly with the recovery of atrial mechanical function.. The reduction of plasma atrial natriuretic peptide levels after direct current cardioversion might be due to recovery from the high rate of atrial firing and not to an alteration in the mitral pressure gradient. Direct current cardioversion itself does not seem to influence atrial natriuretic peptide secretion. The increase in atrial natriuretic peptide levels from 4 h to 5 days after cardioversion concomitantly with an increase in atrial filling fraction may be due to recovery of atrial mechanical function.

Topics: Adult; Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Blood Flow Velocity; Echocardiography, Doppler; Electric Countershock; Female; Hemodynamics; Humans; Male; Middle Aged; Mitral Valve Stenosis

Topics: Adolescent; Adult; Atrial Fibrillation; Atrial Natriuretic Factor; Electric Countershock; Heart Rate; Humans; Middle Aged

The plasma level of atrial natriuretic factor and its relation to intracardiac and systemic hemodynamic parameters were examined in patients with coronary heart, rheumatic and mitral valvular diseases, neurocirculatory dystonia which were complicated by atrial fibrillation. The concentration of atrial natriuretic factor was found to vary with the left ventricular myocardial mass, left atrial contractility, antiarrhythmic therapy intensity and efficacy.

Topics: Adult; Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Cardiovascular Diseases; Female; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Contraction

Topics: Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Female; Humans; Male; Middle Aged; Myocardium; Natriuretic Peptide, Brain; Nerve Tissue Proteins; Tachycardia, Supraventricular

Topics: Atrial Fibrillation; Atrial Flutter; Atrial Natriuretic Factor; Electric Countershock; Guanosine Monophosphate; Humans

We investigated atrial natriuretic peptide (ANP) and cyclic guanosine monophosphate (cGMP) in patients undergoing elective direct current cardioversion (CV group) due to atrial fibrillation (n = 9) or atrial flutter (n = 3). Anesthesia for cardioversion (CV) was induced with propofol 1.5 mg/kg. Conversion was achieved in all patients. Before CV all patients had elevated ANP and cGMP plasma levels. After CV the concentrations of ANP and cGMP decreased significantly within 15 and 30 minutes (p less than 0.01), respectively. Only one patient in the CV group showed increasing ANP and cGMP levels although his heart rate had decreased after CV and his blood pressure remained stable. High concentrations of ANP and cGMP might possibly be a compensatory mechanism of cardiac dysfunction. To study the influence the anesthetic agent on plasma levels of ANP and cGMP, we investigated six patients anesthetized with propofol for high-density radiation (HDR group). The data from this control group showed that propofol did not influence the plasma levels of ANP and cGMP. ANP correlated statistically significantly (p less than 0.05) with cGMP in both groups (r = 0.88 and 0.76 in the HDR and CV groups, respectively). In addition, we found a cGMP release of 149.6 +/- 17.6 per mol ANP in the HDR group, in the CV group the release was 109 +/- 54.2 cGMP per mol ANP. This phenomenon could be due to minor response of target cells to ANP stimulation (receptor down-regulation) in patients with heart disease. In conclusion, ANP and cGMP levels decreased after successful cardioversion.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Anesthesia, Intravenous; Atrial Fibrillation; Atrial Flutter; Atrial Natriuretic Factor; Blood Pressure; Cyclic GMP; Electric Countershock; Female; Hemodynamics; Humans; Male; Middle Aged; Propofol

Plasma atrial natriuretic peptide (ANP) concentrations were measured before and 1 hour after cardioversion in 40 patients (27 with atrial flutter and 13 with atrial fibrillation) admitted for elective cardioversion. Fourteen (11 with atrial flutter and 3 with atrial fibrillation) had clinical evidence of congestive heart failure (CHF). Conversion to sinus rhythm was successful in 39 patients. The mean ANP concentration in the entire group decreased after cardioversion from 38 +/- 4 to 17 +/- 2 pmol/liter (p less than 0.001). In the subgroup with CHF, the ANP level, which was not significantly higher than that in the group without CHF, decreased from 47 +/- 8 to 19 +/- 3 pmol/liter (p less than 0.01). Neither mode of cardioversion (spontaneous 1, pharmacologic 2 and direct-current countershock 36) nor associated CHF influenced ANP response to cardioversion. One patient with atrial flutter and "failed cardioversion" had unchanged ANP level. The decrease after cardioversion in ANP concentration correlated with its control level (r = 0.88, p less than 0.001) but not with the decrease in heart rate. The ANP level in patients with atrial fibrillation was 45 +/- 9 vs 38 +/- 5 pmol/liter in those with atrial flutter (difference not significant). Arrhythmia duration, left atrial size, and ventricular rate or arterial blood pressure did not correlate with ANP concentration in any subgroup. It is concluded that (1) the ANP level is elevated comparably in patients with both atrial flutter and fibrillation regardless of the presence or absence of CHF; and (2) the level decreases, independent of the mode of cardioversion or presence of CHF, promptly after successful cardioversion.

Topics: Aged; Aged, 80 and over; Atrial Fibrillation; Atrial Flutter; Atrial Natriuretic Factor; Electric Countershock; Female; Heart Atria; Heart Failure; Humans; Male

Aim of this study was to evaluate if captopril treatment may directly alter the trial natriuretic factor (ANF) concentration. Six patients (2 male and 4 female) aged 53 +/- 11 years, with mitral stenosis, and atrial fibrillation, underwent cardiac catheterization in our Institution. The following parameters were evaluated: heart rate, right atrial and pulmonary capillary wedge pressure, aortic and pulmonary pressure, cardiac index, pulmonary and systemic resistances and ANF concentration in coronary sinus, pulmonary, artery, aorta, peripheral vein. All these parameters were measured before and 30 and 60 min after captopril administration (50 mg orally). No hemodynamic changes occurred after captopril administration. No changes in ANF concentration occurred in comparison with baseline levels, after 30 and 60 min in coronary sinus (199.8 +/- 151.5 vs 181.9 +/- 102.5 fmol/ml; 178.4 +/- 95.2 vs 181.9 +/- 102.5 fmol/ml), in pulmonary artery (58.3 +/- 36.6 vs 51.4 +/- 48.8 fmol/ml; 35.5 +/- 16.9 vs 51.4 +/- 48.8 fmol/ml), in aorta (29.7 +/- 22.7 vs 37.5 +/- 26.3 fmol/ml; 25.2 +/- 9.8 vs 37.5 +/- 26.3 fmol/ml); and in peripheral vein (14.6 +/- 7.9 vs 17.3 +/- 9.7 fmol/ml; 16.2 +/- 12.2 vs 17.3 +/- 9.7 fmol/ml). In conclusion our data show that, providing no hemodynamic changes occur, captopril administration does not alter ANF concentration.

Topics: Adult; Atrial Fibrillation; Atrial Natriuretic Factor; Captopril; Female; Hemodynamics; Humans; Male; Middle Aged; Mitral Valve Stenosis; Time Factors; Tricuspid Valve Insufficiency

The aim of the present study was to determine whether left atrial size--a likely indicator of atrial stretching--correlates with the plasma concentration of atrial natriuretic peptide and whether this relation is different in patients in sinus rhythm and in those with atrial fibrillation. Arterial plasma concentrations of immunoreactive atrial natriuretic peptide (ir-ANP), adrenaline, noradrenaline, aldosterone, and vasopressin were measured in 13 patients in sinus rhythm without apparent heart failure and in 13 patients in atrial fibrillation. The two groups were matched for left atrial diameter and the ratio of the left atrial diameter to the diameter of the aortic root (assessed by echocardiography). There were no significant differences in age, heart rate, blood pressure, or left ventricular end diastolic diameter between the two groups. Left atrial diameters varied from 33 to 60 mm. The mean (SD) plasma concentration of ir-ANP was significantly higher (35 (21) pmol/l) in the patients with atrial fibrillation than in those in sinus rhythm (12 (11) pmol/l). The concentration of plasma aldosterone was also higher in patients with atrial fibrillation (831 (366) v 523 (211) pmol/l). Concentrations of adrenaline, noradrenaline, and vasopressin were similar in both groups. None of the hormone concentrations correlated with left atrial dimensions. These results indicate that plasma concentrations of ir-ANP and aldosterone are highly sensitive indicators of changes in haemodynamic function during atrial fibrillation. They also underscore the difficulties of correlating echocardiographic assessment of patients with plasma concentrations of a vasoactive hormone.

Topics: Aldosterone; Arginine Vasopressin; Atrial Fibrillation; Atrial Natriuretic Factor; Chronic Disease; Epinephrine; Heart Atria; Hemodynamics; Humans; Middle Aged; Myocardium; Norepinephrine

Recently two peptides consisting of amino acids (AA) 1-30 and 31-67 of the N-terminus of the 126 AA prohormone of atrial natriuretic factor (pro ANF) as well as atrial natriuretic factor (ANF, AA 99-126; C-terminus) were found to have vasodilatory and natriuretic properties. These peptides as well as ANF circulate in man as part of the N-terminus of the prohormone. To determine if the polyuria, associated with both ventricular and supraventricular arrhythmias, is associated with increased circulating concentrations of the N-terminus and C-terminus of the ANF prohormone, 20 individuals with spontaneous arrhythmias, including ten persons with atrial fibrillation, six with paroxysmal supraventricular tachycardia, and four with ventricular tachycardia, were evaluated before and after conversion to sinus rhythm. In all 20 patients, the circulating concentrations of the whole N-terminus (ie, AA 1-98), the midportion of the N-terminus (pro ANF 31-67) that circulates as a distinct 3900 molecular weight peptide after being proteolytically cleaved from the N-terminus, and the C-terminus were significantly higher (p less than 0.001) than their concentration in 54 persons with sinus rhythm. With conversion to sinus rhythm, the plasma C-terminus concentration of these 20 arrhythmia patients decreased to the level of persons with sinus rhythm within 30 minutes.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aged; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Natriuretic Factor; Female; Heart Rate; Humans; Male; Middle Aged; Molecular Weight; Radioimmunoassay; Tachycardia; Tachycardia, Supraventricular

The present study reports about novel findings concerning the interrelationship between release of human atrial natriuretic factor (hANP) and the clinical situation of patients suffering from congestive heart failure. Estimations of plasma hANP were done by specific and sensitive extraction-based RIA. The normal range was 5 to 80 ng/l, mean +/- SEM = 30 +/- 15 ng/l, n = 106. Influence of response to therapy on hANP-release was studied in altogether 14 patients. 12 of these patients had elevated plasma hANP at admittance, surprisingly peptide levels were normal in 2 patients throughout the study. 9 out of the 14 patients responded well to therapy (shift from NYHA IV/III to NYHA II within about 10 days), hANP-levels decreased to normal values: 235 +/- 104 ng/l vs. 65 +/- 13 ng/l; p less than 0.001. The 5 residual patients responded to therapy only partially (shift from HYHA IV to NYHA III within an observation interval of about 2 weeks). Plasma hANP values decreased from 225 +/- 94 ng/l to 137 +/- 22 ng/l (p less than 0.02), but were still supranormal. Atrial fibrillation, which persisted in 8 out of the 14 patients after therapy did not influence hANP levels: hANP levels paralleled clinical signs of improvement, irrespective of atrial fibrillation. Right heart catheterization revealed very high mean right atrial pressures in those 2 patients mentioned above, who had normal pretherapeutic hANP.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Atrial Fibrillation; Atrial Flutter; Atrial Natriuretic Factor; Blood Pressure; Cardiac Output; Cardiomyopathies; Cardiotonic Agents; Diuretics; Female; Heart Failure; Heart Valve Diseases; Humans; Longitudinal Studies; Male

The aim of this paper was to study atrial natriuretic factor, plasma renin activity and antidiuretic hormone values during paroxysmal atrial arrhythmias with different ventricular rates before and after pharmacological cardioversion and during chronic atrial flutter-fibrillation. The study was carried out: 1) during acute arrhythmias (atrial flutter-fibrillation or supraventricular tachycardia) and after restoration of normal sinus rhythm in 2 patients without heart disease, in 13 with chronic heart disease and in 6 with acute myocardial infarction; 2) during chronic atrial flutter-fibrillation in 5 patients with chronic ischemic heart disease, without congestive heart failure. Atrial natriuretic factor, aldosterone, plasma renin activity and antidiuretic hormone values were measured by radio-immunoassay. During paroxysmal atrial arrhythmias atrial natriuretic factor levels were higher than normal in all patients, particularly in those with supraventricular tachycardia. Most of the aldosterone measurements were above the normal range. As far as plasma renin activity and antidiuretic hormone values are concerned, levels higher than the normal range were found in the patients with severe hemodynamic impairment. Central venous pressure was above normal in all patients except in the 2 without heart disease, and there was a positive correlation between atrial natriuretic factor and central venous pressure values. After restoration of normal sinus rhythm atrial natriuretic factor values returned to normal except in acute myocardial infarction patients, in 1 chronic ischemic heart disease patient with congestive heart failure and in 3 patients with mitral valve disease. In all patients with chronic atrial flutter-fibrillation and in 5 patients with acute atrial flutter-fibrillation and low rate, above normal atrial natriuretic factor values were found with normal central venous pressure values. Atrial distension due to high central venous pressure values, lack of atrial contraction and rhythmic detension of the atrial stretch receptors, may be considered the major stimuli responsible for atrial natriuretic factor release during acute paroxysmal atrial arrhythmias and atrial flutter-fibrillation with low ventricular rate, respectively.

Topics: Acute Disease; Adult; Aged; Aldosterone; Atrial Fibrillation; Atrial Flutter; Atrial Natriuretic Factor; Blood Pressure; Central Venous Pressure; Chronic Disease; Female; Humans; Male; Middle Aged; Renin; Tachycardia, Supraventricular; Vasopressins

To study the relation between plasma atrial natriuretic factor (ANF) and cardiac pressures, we measured plasma ANF in 24 patients with mitral stenosis 30 minutes before and 20 minutes after balloon mitral valvulotomy. All patients were without physical signs of congestive heart failure. Normal sinus rhythm was present in 15 (group 1), whereas the other nine (group 2) had permanent atrial fibrillation. There were no significant differences between groups for basal mean pressures in right atrium (RA), left atrium (LA), and pulmonary artery (PA). Valvulotomy resulted in a fall in both groups (p less than 0.001) in LA and PA mean pressures, whereas heart rate, cardiac index, and RA and aorta (AO) pressures did not change significantly. Basal ANF was not different in either group in RA (240 +/- 43 vs. 266 +/- 35 pg/ml) or AO (441 +/- 92 vs. 643 +/- 70 pg/ml) but tended to be higher in group 2 in LA (428 +/- 88 vs. 682 +/- 84 pg/ml; p = 0.059) and PA (488 +/- 93 vs. 759 +/- 92 pg/ml; p = 0.057). Plasma ANF was the highest in PA, and about 50% ANF was extracted in the systemic circulation. After valvulotomy, plasma ANF was greater (p less than 0.05) in group 2 (372 +/- 90, 755 +/- 152, 805 +/- 134, and 707 +/- 144 pg/ml) than in group 1 (206 +/- 36, 386 +/- 47, 429 +/- 66, and 421 +/- 49 pg/ml), regardless of the site of blood collection (RA, LA, PA, and AO, respectively). PA ANF was correlated with LA pressure (p less than 0.05) in group 1 before as well as after valvulotomy, whereas there was no such correlation in group 2. Cyclic GMP (cGMP) in LA was correlated (p less than 0.01) with PA ANF in group 1, and LA cGMP (10.0 +/- 1.2 and 9.1 +/- 1.8 pmol/ml in groups 1 and 2, respectively) was higher (p less than 0.05) than PA cGMP (9.1 +/- 1.0 and 8.0 +/- 1.5 pmol/ml in groups 1 and 2, respectively) before valvulotomy, which suggests the presence of ANF receptors in the pulmonary circulation. Taken together, these results indicate that in patients in sinus rhythm with mitral stenosis, there is an increase in ANF secretion depending on LA pressure. ANF secretion is also high in patients with mitral stenosis and atrial fibrillation but does not respond appropriately to changes in LA pressure.(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Aldosterone; Atrial Fibrillation; Atrial Natriuretic Factor; Catheterization; Coronary Circulation; Cyclic GMP; Female; Hemodynamics; Humans; Male; Mitral Valve Stenosis; Renin; Veins

Plasma concentrations of immunoreactive atrial natriuretic polypeptide were raised in 22 of 23 patients with paroxysmal supraventricular tachycardia and in all seven patients with atrial flutter. Plasma concentrations of atrial natriuretic polypeptide rose soon after the onset of supraventricular tachycardia. A sample taken 30 minutes after reversion to sinus rhythm (pharmacological or non-pharmacological) showed a significant fall in 19 of the 23 patients with paroxysmal supraventricular tachycardia and all seven patients with atrial flutter. Because atrial natriuretic polypeptide has powerful natriuretic and diuretic properties, an increase may contribute considerably to the polyuria that is often associated with episodes of supraventricular tachycardia.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Atrial Fibrillation; Atrial Flutter; Atrial Natriuretic Factor; Female; Humans; Male; Middle Aged; Radioimmunoassay; Tachycardia, Supraventricular; Time Factors

In eight patients with atrial fibrillation of less than 3 months duration and without congestive heart failure the plasma concentration of atrial natriuretic peptide was determined one day before, the day after and again 30 days after electrical cardioversion therapy. The pretreatment plasma concentration of the peptide was 99 pg mg-1 (23-480, median and range). The day after cardioversion to sinus rhythm the peptide concentration had normalized to 36 pg ml-1 (18-151). The plasma concentration of atrial natriuretic peptide remained stable in all but one patient for a period of 30 days (46 pg ml-1, 16-695) (P = 0.03). In conclusion, the plasma concentration of atrial natriuretic peptide in patients with atrial fibrillation was significantly reduced after electrical cardioversion to sinus rhythm and remained stable for a period of 30 days.

Topics: Adult; Atrial Fibrillation; Atrial Natriuretic Factor; Electric Countershock; Hemodynamics; Humans; Male; Middle Aged

Topics: Adult; Atrial Fibrillation; Atrial Flutter; Atrial Natriuretic Factor; Cardiac Catheterization; Heart Transplantation; Humans; Male

Plasma immunoreactive atrial natriuretic factor was measured in 10 patients with chronic atrial fibrillation before and after cardioversion to sinus rhythm, and in 14 patients during electrophysiologic evaluation of paroxysmal supraventricular tachycardia. The mean plasma concentration of atrial natriuretic factor in atrial fibrillation was 138 +/- 48 pg/ml and decreased to 116 +/- 45 pg/ml 1 hour after cardioversion to sinus rhythm (p less than 0.005). The mean plasma concentration of atrial natriuretic factor increased from 117 +/- 53 pg/ml in sinus rhythm to 251 +/- 137 pg/ml during laboratory-induced supraventricular tachycardia (p less than 0.005). Right atrial pressures were recorded in 12 patients; the baseline atrial pressure was 4.3 +/- 1.9 mm Hg and increased to 7.4 +/- 3.6 mm Hg during supraventricular tachycardia (p less than 0.005). A modest but significant linear relation was noted between the changes in plasma atrial natriuretic factor and right atrial pressure measurements during induced supraventricular tachycardia (r = 0.60, p less than 0.05). In conclusion, changes in atrial rhythm and pressure may be an important factor modulating the release of atrial natriuretic factor in the circulation and raised levels of this hormone may be a contributing factor for the polyuria and the hypotension associated with paroxysmal supraventricular tachyarrhythmias.

Topics: Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Electric Countershock; Electrophysiology; Female; Heart Rate; Humans; Male; Middle Aged; Tachycardia

In an attempt to clarify the clinical significance of atrial natriuretic peptide (ANP) in man, plasma levels of immunoreactive ANP were studied in patients with heart diseases and in those with chronic renal failure. When ANP concentrations in pulmonary arterial plasma were compared with hemodynamic variables in patients with heart diseases who underwent cardiac catheterization, a significant positive correlation was found between plasma ANP levels and mean pulmonary capillary wedge pressure, while plasma ANP levels were not significantly correlated to mean right atrial pressure (MRAP). After the injection of contrast medium, both MRAP and plasma ANP levels increased and a significant positive correlation was observed between two variables. Plasma levels of ANP were elevated in patients with congestive heart failure according to the severity. In addition, patients associated with atrial fibrillation showed significantly higher plasma ANP levels than those on sinus rhythm. In patients with paroxysmal atrial arrhythmias, plasma ANP levels increased markedly during paroxysms. Patients with chronic renal failure had elevated plasma ANP levels, which fell after hemodialysis. These results suggest that both left and right atrial tissue can secrete ANP as a result of stretching of the cardiocytes in man and that plasma ANP levels are elevated in patients with congestive heart failure and in those with chronic renal failure by increased atrial pressure due to volume expansion. Abnormal atrial contraction per se, in addition, may stimulate ANP secretion.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Atrial Natriuretic Factor; Cardiac Catheterization; Female; Heart Diseases; Heart Failure; Humans; Kidney Failure, Chronic; Male; Middle Aged; Pulmonary Wedge Pressure; Renal Dialysis

To investigate the mechanisms of polyuria associated with tachycardia, we measured plasma concentrations of alpha-human atrial natriuretic polypeptide (alpha-hANP) and cGMP in 6 patients with paroxysmal tachycardia. Plasma concentrations of immunoreactive alpha-hANP and cGMP increased by +69% (p less than 0.05) and +100% (p less than 0.05), respectively, during both paroxysmal atrial tachycardia and atrial fibrillation. To examine whether tachycardia per se raises the secretion of alpha-hANP, we also determined plasma concentrations of alpha-hANP and cGMP in 5 patients during rapid atrial pacing. The pacing-induced tachycardia also increased both of the plasma concentrations. Further, the examinations of cardiac and renal functions in patients with complete atrioventricular block during rapid pacing revealed that each of the increases in atrial pressures, urinary sodium excretion and creatinine clearance were in parallel with the change in plasma concentration of alpha-hANP. These results suggest that an increase in plasma concentration of alpha-hANP during paroxysmal tachycardia is mainly due to elevation of atrial pressure and that this increase in alpha-hANP contributes to tachycardia polyuria.

Topics: Atrial Fibrillation; Atrial Natriuretic Factor; Cardiac Pacing, Artificial; Cyclic GMP; Heart; Heart Block; Humans; Kidney; Middle Aged; Radioimmunoassay; Tachycardia, Paroxysmal; Time Factors

To determine the influence of atrial pressure, heart rate and loss of atrial-ventricular synchrony in the release of atrial natriuretic peptide (ANP), plasma ANP concentrations were measured by radio-receptor assay in 12 patients during diagnostic cardiac catheterization and in patients with atrial fibrillation and during cardiac pacing. There was a relationship between right atrial pressure and right atrial ANP concentration (r = 0.813, p less than 0.01). Acute loss of atrial-ventricular pacing mode induced an increase in plasma ANP concentration from 44 +/- 8 to 104 +/- 13 pmol/l (n = 11, p less than 0.01) provided that systemic blood pressure was maintained. In contrast, if hypotension developed during ventricular pacing, the ANP levels fell from 68 +/- 11 to 14 +/- 7 pmol/l (n = 5, p less than 0.05) within five minutes despite elevation of atrial pressure. We therefore conclude that atrial pressure and the loss of atrioventricular synchrony may profoundly alter ANP release. The fall in plasma ANP concentration in acute hypotension suggests that, in addition to atrial pressure, ANP release is controlled by a peripheral negative feedback mechanism.

Topics: Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Blood Pressure; Female; Heart Atria; Humans; Male; Middle Aged