title: Effect of candesartan and various inflammatory markers on maintenance of sinus rhythm after electrical cardioversion for atrial fibrillation.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Asker & Baerum Hospital, Rud, Norway. arnljot.tveit@broadpark.no
authors.forename: Arnljot
authors.initials: A
authors.lastname: Tveit
authors.forename: Ingebjørg
authors.initials: I
authors.lastname: Seljeflot
authors.forename: Irene
authors.initials: I
authors.lastname: Grundvold
authors.forename: Michael
authors.initials: M
authors.lastname: Abdelnoor
authors.forename: Pal
authors.initials: P
authors.lastname: Smith
authors.forename: Harald
authors.initials: H
authors.lastname: Arnesen
mesh_terms: 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
chemical_list: 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