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The Role of the Post Cardioversion Time Course of hs-CRP Levels in Clarifying the Relationship between Inflammation and Persistence of Atrial Fibrillation
  1. Eleftherios Michael Kallergis (heartjournal{at}bmjgroup.com)
  1. Heraklion University Hospital, Greece
    1. Emmanuel G Manios
    1. Heraklion University Hospital, Greece
      1. Emmanuel M Kanoupakis
      1. Heraklion University Hospital, Greece
        1. Hercules E Mavrakis
        1. Heraklion University Hospital, Greece
          1. Stavroula G Kolyvaki
          1. Heraklion University Hospital, Greece
            1. George M Lyrarakis
            1. Heraklion University Hospital, Greece
              1. Gregory I Clouverakis
              1. Heraklion University Hospital, Greece
                1. Panos E Vardas
                1. Heraklion University Hospital, Greece

                  Abstract

                  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.

                  • Atrial fibrillation
                  • C-reactive protein
                  • Cardioversion
                  • Inflammation

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