Methods: In 54 patients (pat.) with recently discovered AF, BNP plasma levels were measured by a quantitative bedside test before TEE (transesophageal echocardiography)-guided cardioversion. Transthoracic Echocardiography (TTE) and TEE were used to evaluate left atrial size (LAS), LA spontaneous echo contrast (SEC), left atrial appendage thrombus (LAAT) and LAA flow (LAAF).

Results:

5 pat. showed LAAT in TEE (10%), 3 patients converted spontaneously to SR, 5 pat. refused TEE, 5 pat. refused cardioversion. 36 patients were treated with DCC, SR was restored in 31 pat. (86%). 17 of 36 pat. remained in SR after 1 month (47%), no thromboembolic event occurred. BNP was significantly elevated in pat. with LAAT (764±409 pg/ml vs. 228±206 pg/ml; p=0.001), with SEC (440±340 pg/ml vs. 206±207 pg/ml; p=0.003), with a low LAAF <25 cm/s (554±354 pg/ml) vs. normal LAAF >40 cm/s (152±140; p<0.0001), with an increased LAS of >50 mm (543±418 pg/ml) vs. normal LAS <40 mm (124±85 pg/ml; p=0.006). One month maintenance of SR was predicted by high LAAF or low BNP 110±97 pg/ml. Pat. with recurrence of AF showed significant higher BNP levels: 359±239 pg/ml (p<0.0001).