Association of inflammatory factors with occurrence and recurrence of atrial fibrillation: A meta-analysis

• Published in: International journal of cardiology Vol. 169; no. 1; pp. 62 - 72
• Main Authors: Wu, Na, Xu, Bin, Xiang, Ying, Wu, Long, Zhang, Yao, Ma, Xiangyu, Tong, Shifei, Shu, Maoqing, Song, Zhiyuan, Li, Yafei, Zhong, Li
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 25.10.2013; Elsevier
• Subjects: Atrial fibrillation; Atrial Fibrillation - blood; Atrial Fibrillation - epidemiology; Atrial Fibrillation - pathology; Biological and medical sciences; Biomarkers - blood; C-Reactive Protein - metabolism; Cardiac dysrhythmias; Cardiology. Vascular system; Cardiovascular; Catheter ablation; Coronary artery bypass grafting surgery; Coronary heart disease; Electrical cardioversion; Heart; Humans; Inflammation Mediators - blood; Inflammatory factor; Interleukin-6 - blood; Interleukin-8 - blood; Medical sciences; Meta-analysis; Observational Studies as Topic - methods; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Recurrence; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Tumor Necrosis Factor-alpha - blood; Electrical cardioversion; Coronary artery bypass grafting surgery; Atrial fibrillation; Inflammatory factor; Catheter ablation; Meta-analysis; Recurrence; Relapse; Arrhythmia; Catheter; Cardioversion; Cardiovascular disease; Evidence-based medicine; Metaanalysis; Association; Graft; Cardiology; Intensive cardiocirculatory care; Evidence-based practice; Instrumentation therapy; Inflammation; Ablation; Coronary heart disease; Excitability disorder; Coronary artery bypass
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2013.08.078

Abstract Background The role of circulating inflammatory factors in atrial fibrillation (AF) occurrence and recurrence remains inconclusive. Methods We conducted a meta-analysis of observational studies evaluating the association of inflammatory factors with AF risk, postoperative AF (POAF) occurrence after coronary artery bypass grafting (CABG) surgery, and AF recurrence after electrical cardioversion (EC) or catheter ablation. Results Increased C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor-α were significantly associated with AF risk (standardized mean difference [SMD] [95% confidence interval (CI)]: 0.95 [0.72–1.18], 0.89 [0.64–1.15] and 2.20 [1.17–3.23], respectively). In subgroup analysis, CRP was significantly associated with persistent and permanent AF risk, but not with paroxysmal AF. Increased preoperative CRP and IL-6 were associated with greater risk of post-CABG AF (SMD [95% CI]: 0.28 [0.02–0.54] and 1.03 [0.03–2.04], respectively). Consistent significant associations between CRP and AF recurrence were found in both patient subgroups who underwent EC (SMD, 0.56; 95% CI, 0.36–0.76) and ablation (SMD, 0.48; 95% CI, 0.11–0.86). IL-6 was significantly associated with AF recurrence after ablation (SMD, 0.55; 95% CI, 0.25–0.85), but not with the recurrence after EC (SMD, 0.85; 95% CI, − 0.26–1.95). Conclusion Increased circulating inflammatory factors, such as CRP and IL-6, are associated with greater AF risk in general population and patients who underwent CABG, as well as with AF recurrence after EC or ablation. Future research is warranted to elucidate the roles of other inflammatory markers, such as white blood cell, IL-8, and transforming growth factor-β1, in occurrence and recurrence of well-established different clinical subtypes of AF.