This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Atrial fibrillation is the most common chronic arrhythmia in adults, accounting for over 30% of arrhythmia-related hospitalizations in the United States. It is associated with profound morbidity especially stroke and a significant two-fold increase in mortality. Recent trials indicate that controlling the rate might be a preferable strategy to controlling the irregular rhythm itself. However in certain patient subgroups this arrhythmia is not well tolerated and is associated with perturbing symptoms like palpitations, frequent hospitalizations for congestive heart failure and even stroke. This therefore makes it imperative to maintain normal sinus rhythm whenever possible. However recurrence of this arrhythmia even after successful cardioversion is still common especially within the first month. Studies examining the factors that determine which patients are likely to have a recurrence have yielded conflicting results. Brain natriuretic peptide (BNP) is a novel blood test that is helpful in the diagnosis of patients with heart failure and provides useful information in patients with blood clots in the lung and even coronary artery disease. Although BNP is produced mainly in the ventricles, a certain proportion is released from the atrium too. BNP is raised in patients with atrial fibrillation and its level decreases following cardioversion. Indeed BNP has also been shown to be predictive of the risk of atrial fibrillation. The left atrium can enlarge in patients with atrial fibrillation and restoration of normal sinus rhythm usually causes regression of the dilatation. Left atrial volume index is a superior parameter of left atrial size and has been shown to predict the onset of atrial fibrillation in the elderly population. The hypothesis is that BNP and left atrial volume are predictors of the recurrence of atrial fibrillation following cardioversion. This prospective study intends to enroll patients over the age of 18 years with atrial fibrillation that are referred for cardioversion by their cardiologists. Patients will be followed for one month to determine the recurrence of atrial fibrillation. A baseline BNP will be obtained just prior to cardioversion and then a follow-up level at one month. The left atrial volume index shall be measured from a transthoracic echocardiogram obtained at least within a month of the cardioversion. Follow up will also involve a phone interview at 2 weeks and an electrocardiogram at one month. We anticipate that patients with relatively higher BNP levels and larger left atrial volume indices prior to cardioversion will have higher rates of recurrence of atrial fibrillation at one month.
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