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 one month. Baseline hs-CRP was higher in patients with AF recurrence compared to those who remained in SR (0.5±0.18 mg/dl vs. 0.29±0.13 mg/dl, respectively, p<0.001). Similarly, arrhythmia recurrence was associated with greater left atrial diameters (45.4±3.3 mm vs. 40.7±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±0.06 mg/dl vs. 0.29±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±0.24 mg/dl vs. 0.50±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 results 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.
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