Téma:  Case Studies

Coffee, nt-probnp and recurrence of atrial fibrillation

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.

Ročník 2008  Témy časopisu Cardiology for practice 4 / 2008

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Examples of citations:
1. Shaheen NJ, Crosby NA, Bozymski EM, et al. Is there publication bias in the reporting cancer risk in Barrett´ esophagus? Gastroenterology 2000; 119: 333-338.
2. Stenestrand U, Wallentin L. Swedish Register of Cardiac Intensive Care (RIKS-HIA): Early statin treatment following acute myocardial infarction and 1-year survival. JAMA 2001; 285: 430-436.
3. LIPID Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med 1998; 339: 1349-1357.
4. Jurkovičová O, Spitzerová H, Cagáň S. Komorové arytmie a náhla srdcová smrť pri akútnom infarkte myokardu. Bratisl Lek Listy 1997; 98: 379-389.
5. Osborne BE. The electrocardiogram of the rat. In: Budden R, Detweiler DK, Zbinden G. The rat electrocardiogram in pharmacology and toxicology. Oxford: Pergamon Press 1981: 15-27.

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In which patients, after overcoming of a thromboembolic cerebral or peripheral event, the least suitable catheter closure is foramen ovale patents:
a. a woman before planned pregnancy
b. paroxysmal fibrillation of the atrium
c. aneurysm of the atrium septum
d. origination of an event after cough

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