Journal Article

C-reactive protein for prediction of atrial fibrillation recurrence after catheter ablation

Aeschbacher, Stefanie, Knecht, Sven, Osswald, Stefan, Meyre, Pascal B., Kühne, Michael, Blum, Steffen, Spies, Florian, Conen, David, Sticherling, Christian, Voellmin, Gian, Madaffari, Antonio

2020

Overview

Background Inflammation plays an important role in the initiation and progression of atrial fibrillation (AF), but data about the relationship between subclinical inflammation and recurrence of AF after catheter ablation remains poorly studied. We aimed to assess whether plasma levels of C-reactive protein (CRP) are associated with long-term AF recurrence following catheter ablation. Methods Prior to the intervention, plasma CRP concentrations were measured in patients who underwent first catheter ablation for AF. AF recurrence was evaluated after 12 months and defined as any AF episode longer than 30 s recorded on either 12-lead electrocardiogram, 24-h Holter or 7-day Holter monitoring. Multivariable adjusted Cox models were constructed to examine the association of CRP levels and AF recurrence. Results Of the 711 patients (mean age: 61 years, 25% women) included in this study, 247 patients (35%) experienced AF recurrence after ablation. Patients who were in the highest CRP quartile had a higher rate of recurrent AF compared to those who were in the lowest quartile (53.4 vs. 33.1% at 1 year of follow-up; P  = 0.004). The adjusted hazard ratios (aHR) of recurrent AF across increasing quartiles of CRP were 1.0 (reference), 1.26 (95% confidence interval [CI], 0.86–1.84), 1.15 (95% CI, 0.78–1.70) and 1.60 (95% CI, 1.10–2.34) (P trend = 0.015). A similar effect was observed when CRP was analyzed as continuous variable (aHR per unit increase, 1.21; 95% CI, 1.05–1.39; P  = 0.009). When a predefined CRP cut-off of 3 mg/l was applied, patients with CRP levels of 3 mg/l or above had a higher risk of AF recurrence than those with levels below (aHR, 1.44; 95% CI, 1.06–1.95; P  = 0.019). Conclusions Increasing pre-interventional CRP levels are associated with a higher risk of AF recurrence in patients undergoing catheter ablation for AF. Trail registration ClinicalTrials.gov identifier, NCT03718364.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Ablation / Age / Aged / Angiology / Arrhythmias and Electrophysiology / Atrial fibrillation / Atrial Fibrillation - blood / Atrial Fibrillation - diagnosis / Atrial Fibrillation - surgery / Biomarkers - blood / Blood / Blood Transfusion Medicine / C-reactive protein / C-Reactive Protein - analysis / Cardiac arrhythmia / Cardiac Surgery / Cardiology / Cardioversion / Care and treatment / Catheter ablation / Catheter Ablation - adverse effects / Catheters / EKG / Female / Fibrillation / Health aspects / Heart failure / Humans / Hypertension / Inflammation / Internal Medicine / Male / Measurement / Medicine / Medicine & Public Health / Middle Aged / Plasma levels / Prognosis / Prospective Studies / Proteins / Radiofrequency ablation / Recurrence / Recurrence (Disease) / Research Article / Risk Assessment / Risk Factors / Time Factors / Treatment Outcome / Up-Regulation / Variables