title: Relation of C-reactive protein to long-term risk of recurrence of atrial fibrillation after electrical cardioversion.
abstract: The aim of this study is to assess the role of C-reactive protein (CRP) in predicting long-term risk of atrial fibrillation (AF) recurrence after electrical cardioversion. CRP levels are associated with the presence of AF and failure of electrical or pharmacologic cardioversion, but no previous study has assessed their predictive role in long-term follow-up after successful electrical cardioversion. One hundred two consecutive patients (age 67 +/- 11 years; 58 men) with nonvalvular persistent AF who underwent successful biphasic electrical cardioversion were studied. High-sensitivity CRP was measured immediately before cardioversion. Follow-up was performed up to 1 year in all cases. Patients were divided into 4 groups according to CRP quartiles. Patients in the lowest CRP quartile (<1.9 mg/L) had significantly lower rates of AF recurrence (4% vs 33% at 3 months in the other 3 groups combined, p = 0.007, and 28% vs 60% at 1 year, p = 0.01). The 4 groups were similar in age, gender, ejection fraction, and left atrial size. Survival analysis confirmed that patients in the lowest CRP quartile had a lower recurrence rate (p = 0.02). Cox regression analyses using age, gender, hypertension, diabetes, ejection fraction, left atrial diameter, use of antiarrhythmic drugs, angiotensin-converting enzyme inhibitors or angiotensin II antagonists, and statins, and CRP quartiles as covariates showed that only CRP was independently associated with AF recurrence during follow-up (hazard ratio 4.98, 95% confidence interval 1.75 to 14.26, p = 0.003). In conclusion, low CRP is associated with long-term maintenance of sinus rhythm after cardioversion for nonvalvular AF.
authors.affiliation: Cardiology Department, Sandro Pertini Hospital, Rome, Italy. m.loricchio@tin.it
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Loricchio
authors.forename: Cinzia
authors.initials: C
authors.lastname: Cianfrocca
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Pasceri
authors.forename: Leopoldo
authors.initials: L
authors.lastname: Bianconi
authors.forename: Antonio
authors.initials: A
authors.lastname: Auriti
authors.forename: Leonardo
authors.initials: L
authors.lastname: Calo
authors.forename: Filippo
authors.initials: F
authors.lastname: Lamberti
authors.forename: Antonio
authors.initials: A
authors.lastname: Castro
authors.forename: Claudio
authors.initials: C
authors.lastname: Pandozi
authors.forename: Antonio
authors.initials: A
authors.lastname: Palamara
authors.forename: Massimo
authors.initials: M
authors.lastname: Santini
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000097:blood* / Q000453:epidemiology* / Q000628:therapy; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D004554:Electric Countershock; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D015415:Biomarkers; D018836:Inflammation Mediators; D002097:C-Reactive Protein