The role of the post-cardioversion time course of hs-CRP levels in clarifying the relationship between inflammation and persistence of atrial fibrillation

• Published in: Heart (British Cardiac Society) Vol. 94; no. 2; pp. 200 - 204
• Main Authors: Kallergis, E M, Manios, E G, Kanoupakis, E M, Mavrakis, H E, Kolyvaki, S G, Lyrarakis, G M, Chlouverakis, G I, Vardas, P E
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Cardiovascular Society 01.02.2008; BMJ; BMJ Publishing Group LTD
• Subjects: Acute coronary syndromes; Aged; atrial fibrillation; Atrial Fibrillation - blood; Atrial Fibrillation - etiology; Biological and medical sciences; C-reactive protein; C-Reactive Protein - metabolism; Cardiac arrhythmia; Cardiac dysrhythmias; Cardiology. Vascular system; cardioversion; Chronic Disease; Confidence intervals; Cytokines; Electric Countershock; Family medical history; Female; Heart; Heart attacks; Humans; Inflammation; Laboratories; Male; Medical sciences; Middle Aged; Myocarditis - blood; Myocarditis - complications; Prospective Studies; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Recurrence; Intensive cardiocirculatory care; Arrhythmia; Atrial fibrillation; Instrumentation therapy; Cardiovascular disease; Cardioversion; Inflammation; Time; Excitability disorder; Persistence; Heart disease; Level; Circulatory system; Cardiology; C reactive protein
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/hrt.2006.108688

Objectives:Although recent studies suggest that inflammation is involved in the pathogenesis of atrial fibrillation (AF), it remains controversial whether it is a consequence or a cause of the arrhythmia.Design:Prospective study.Setting:Tertiary referral centre.Patients and Interventions:In 52 patients with persistent AF lasting >3 months, high-sensitivity C-reactive protein (hs-CRP) was measured before and after electrical cardioversion.Measurements and Results:All patients were successfully cardioverted to sinus rhythm (SR), but the recurrence rate was 23% at 1 month. Baseline hs-CRP was higher in patients with AF recurrence than in those who remained in SR (0.5 (SD 0.18) mg/dl vs 0.29 (SD 0.13) mg/dl, respectively, p<0.001). Similarly, arrhythmia recurrence was associated with greater left atrial diameters (45.4 (SD 3.3) mm vs 40.7 (SD 3.1) mm, respectively, p<0.001). However, logistic regression analysis showed that hs-CRP was the only independent predictor for AF recurrence (p<0.001). Additionally, patients who were in SR on final evaluation had significantly lower hs-CRP levels than at baseline (0.10 (SD 0.06) mg/dl vs 0.29 (SD 0.13) mg/dl, respectively, p<0.001), while those who experienced AF recurrence had similar values on final and on initial evaluation (0.56 (SD 0.24) mg/dl vs 0.50 (SD 0.18) mg/dl, respectively, p = 0.42).Conclusion:High levels of hs-CRP are associated with an increased risk of AF recurrence after cardioversion. The restoration and maintenance of SR result in a gradual decrease of hs-CRP while AF recurrence has a different effect, suggesting that inflammation is a consequence, rather than a cause, of AF.