Veronika Pokorná, Oľga Jurkovičová
This case report presents the history of a patient with first documented atrial fibrillation episode of unknown duration. Following oral anticoagulation with warfarin for 6 weeks, the patient underwent a successful electrical cardioversion. The level of NT-proBNP prior to cardioversion was elevated up to 669.8 pg/ml (normal upper limit 150 pg/ml). During an ambulatory control on the 6th day following the cardioversion, the patient was still in sinus rhythm according to the resting ECG. The same day, during continuous ECG monitoring, the recurrence of atrial fibrillation was recorded. This new episode might have been triggered by consumption of strong black coffee. The level of NT-proBNP in the blood sample taken the next day in the morning was significantly elevated up to 2077 pg/ml, even though there were no symptoms of heart failure and despite adequate ventricular rate control. This case report points out that coffee, or rather caffeine might play role in triggering a paroxysm of atrial fibrillation. However, it is possible that more factors were involved in this particular case, such as the activation of the sympathicus system due to pain and fear of stomatological treatment, insufficient control of arterial hypertension and lack of effective antiarrhythmic prophylaxis. The present case report shows that atrial fibrillation is accompanied by significant elevation of NT-proBNP, even in absence of heart failure or tachyarrhythmia. The importance of NT-proBNP for management of atrial fibrillation needs further investigation.