Usefulness of High Sensitivity C-Reactive Protein in Predicting Recurrence of Atrial Fibrillation after Electrical Cardioversion

Background: Recent studies have implicated systemic inflammation in the genesis and maintenance of atrial arrhythmias. This study was designed to assess whether the inflammatory state influences the recurrence of atrial fibrillation (AF) after cardioversion for persistent AF (PerAF). Methods and Results: Twelve patients referred for cardioversion of PerAF lasting more than 2 months (mean duration: 16.8 ± 19.7 months) were included in the study. Body mass index (BMI), serum high-sensitivity C-reactive protein (hs-CRP), atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and left ventricular ejection fraction (LVEF) were measured before cardioversion. Cardioversion was successful in all patients, but AF recurred in 7 patients (58%) during the 6-month follow-up period. There were no significant differences in age, AF duration, LVEF, or ANP or BNP levels between patients with and without recurrent AF. However, the BMI was significantly higher in the patients with recurrent AF than in those without (27.5 ± 4.0 vs. 22.3 ± 2.8, respectively, P = 0.04). The hs-CRP concentration was also significantly higher in the patients with recurrent AF compared with those without (1461 ± 1013 vs. 225 ± 77 ng/mL, respectively, P = 0.04). The left atrial diameter was also significantly greater in patients with recurrence compared with those without (48.3 ± 8.5 vs. 38.3 ± 4.1 mm, respectively, P = 0.02). Conclusion: Inflammation may contribute to the pathogenesis of AF and may be useful in identifying patients most likely to not benefit from cardioversion.