Effect of candesartan and various inflammatory markers on maintenance of sinus rhythm after electrical cardioversion for atrial fibrillation.
Inflammatory markers, their relation to maintenance of sinus rhythm after electrical cardioversion for atrial fibrillation (AF), and the effect of candesartan were investigated in a double-blind placebo-controlled study (CAPRAF). One hundred seventy-one patients with persistent AF were randomly assigned to receive candesartan 8 mg/day or placebo for 3 to 6 weeks before and candesartan 16 mg/day or placebo for 6 months after electrical cardioversion. Serum levels of high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-alpha, interleukin-6, P-selectin, E-selectin, CD-40 ligand, and vascular cell adhesion molecule-1 were measured at baseline and end of study. Compared with patients with a relapse of AF, patients still in sinus rhythm at 6 months after cardioversion (n = 40) had lower baseline hs-CRP and E-selectin levels: median 2.36 mg/L (25th, 75th percentiles 1.28, 4.09) versus 3.44 mg/L (25th, 75th percentiles 1.66, 6.05, p = 0.031) and 32 ng/ml (25th, 75th percentiles 23, 42) versus 37 ng/ml (25th, 75th percentiles 28, 51, p = 0.042), respectively. Neither sustained sinus rhythm for 6 months nor treatment with candesartan had an impact on measured concentrations of markers of inflammation. In conclusion, low hs-CRP and E-selectin at baseline were associated with maintenance of sinus rhythm after electrical cardioversion.
Tveit
Arnljot
A
Department of Internal Medicine, Asker & Baerum Hospital, Rud, Norway. arnljot.tveit@broadpark.no
Seljeflot
Ingebjørg
I
Grundvold
Irene
I
Abdelnoor
Michael
M
Smith
Pal
P
Arnesen
Harald
H
D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000494:pharmacology*; D001281:Atrial Fibrillation / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D001562:Benzimidazoles / Q000494:pharmacology*; D015415:Biomarkers / Q000097:blood; D001713:Biphenyl Compounds; D002097:C-Reactive Protein / Q000187:drug effects / Q000378:metabolism; D023201:CD40 Ligand / Q000097:blood / Q000187:drug effects; D004311:Double-Blind Method; D019040:E-Selectin / Q000097:blood / Q000187:drug effects; D004554:Electric Countershock; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000187:drug effects* / Q000378:metabolism / Q000503:physiopathology*; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D019007:P-Selectin / Q000097:blood / Q000187:drug effects; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012008:Recurrence; D012107:Research Design; D016019:Survival Analysis; D013777:Tetrazoles / Q000494:pharmacology*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000097:blood / Q000187:drug effects; D019010:Vascular Cell Adhesion Molecule-1 / Q000097:blood / Q000187:drug effects
D047228:Angiotensin II Type 1 Receptor Blockers; D001562:Benzimidazoles; D015415:Biomarkers; D001713:Biphenyl Compounds; D019040:E-Selectin; D018836:Inflammation Mediators; D015850:Interleukin-6; D019007:P-Selectin; D013777:Tetrazoles; D014409:Tumor Necrosis Factor-alpha; D019010:Vascular Cell Adhesion Molecule-1; D023201:CD40 Ligand; D002097:C-Reactive Protein; C081643:candesartan