|dc.description.abstracteng||Background and purpose: Diagnosis of atrial fibrillation (Afib) or atrial flutter (Aflutter) can be challenging. Cardiovascular risk factors are associated with Afib/Aflutter development and stroke, thus, diagnosis of paroxysmal Afib/Aflutter is highly relevant because of the possibility of anticoagulation to prevent complications. There is a rising evidence, that Afib is developing in a continuous process, beginning with increasing supraventricular extrasystoles (SVES) and atrial runs (AR) proceeding to paroxysmal and persisting Afib leading to lengthening periods of absolute arrhythmia, finally ending in permanent Afib. Natriuretic peptides are elevated in patients with Afib and predict the development of stroke. We aimed to evaluate the diagnostic value of natriuretic peptide levels in the detection of clinically silent episodes of paroxysmal Afib/Aflutter.
Methods: Patients with cardiovascular risk factors and preserved left ventricular function and risk of or already diagnosed congestive heart failure presenting with sinus rhythm were included into this observational study. N-terminal pro Brain-type Natriuretic Peptide (NT-proBNP) and Brain-type Natriuretic Peptide (BNP) were measured before starting and after the end of a 7-day Holter monitoring, which was carefully screened for Afib/Aflutter. Results: 162 patients were included, 10 (6.2 %) of them had paroxysmal Afib/Aflutter. BNP and NT-proBNP were higher in patients with paroxysmal Afib/Aflutter: before Holter monitoring median (25.-75. percentile) 104.7 (32.9-190.2) vs. 45.9 (16.4-96.0) pg/ml, p=0.061 and 240.4 (86.6-478.0) vs. 53.9 (30.9-184.3) pg/ml, p=0.022, after Holter monitoring 182.6 (102.5-401.5) vs. 46.1 (16.6-99.0) pg/ml, p=0.001 and 274.3 (160.5-746.7) vs. 61.4 (34.3-181.0) pg/ml, p=0.006. For the detection of paroxysmal Afib/Aflutter episodes, BNP and NT-proBNP measured after the Holter monitoring an area under the curve in ROC analysis of 0.82 and 0.84. Patients with Afib/Aflutter had significantly more AR (p=0.002) and SVES (p=0.016). There was a remarkable and statistically significant increase of NT-proBNP and BNP levels in patients with sustained sinus rhythm if numerous AR and SVES could be documented (each p<0.05). Conclusion: Natriuretic peptides are useful biomarkers for the detection of undiagnosed paroxysmal Afib/Aflutter. If natriuretic peptides are elevated, 7-day Holter ECG should be considered. The enhanced and early detection of undiagnosed paroxysmal atrial fibrillation by natriuretic peptides may be a useful strategy in primary stroke prevention. The results of our study indicate that frequent SVES and AR are associated with increased levels of NT-proBNP and BNP. Natriuretic peptide levels are suggestive to reflect the progressive development from frequent SVES/AR to overt atrial fibrillation.||de