title: The role of the post-cardioversion time course of hs-CRP levels in clarifying the relationship between inflammation and persistence of atrial fibrillation.
abstract: OBJECTIVE
  Although recent studies suggest that inflammation is involved in the pathogenesis of atrial fibrillation (AF), it remains controversial whether it is a consequence or a cause of the arrhythmia.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Tertiary referral centre.
  
  
  METHODS
  In 52 patients with persistent AF lasting >3 months, high-sensitivity C-reactive protein (hs-CRP) was measured before and after electrical cardioversion.
  
  
  RESULTS
  All patients were successfully cardioverted to sinus rhythm (SR), but the recurrence rate was 23% at 1 month. Baseline hs-CRP was higher in patients with AF recurrence than in those who remained in SR (0.5 (SD 0.18) mg/dl vs 0.29 (SD 0.13) mg/dl, respectively, p<0.001). Similarly, arrhythmia recurrence was associated with greater left atrial diameters (45.4 (SD 3.3) mm vs 40.7 (SD 3.1) mm, respectively, p<0.001). However, logistic regression analysis showed that hs-CRP was the only independent predictor for AF recurrence (p<0.001). Additionally, patients who were in SR on final evaluation had significantly lower hs-CRP levels than at baseline (0.10 (SD 0.06) mg/dl vs 0.29 (SD 0.13) mg/dl, respectively, p<0.001), while those who experienced AF recurrence had similar values on final and on initial evaluation (0.56 (SD 0.24) mg/dl vs 0.50 (SD 0.18) mg/dl, respectively, p = 0.42).
  
  
  CONCLUSIONS
  High levels of hs-CRP are associated with an increased risk of AF recurrence after cardioversion. The restoration and maintenance of SR result in a gradual decrease of hs-CRP while AF recurrence has a different effect, suggesting that inflammation is a consequence, rather than a cause, of AF.
authors.affiliation: Department of Cardiology, Heraklion University Hospital, 71100, Voutes, Heraklion, Crete, Greece. ekallergis@edu.med.uoc.gr
authors.forename: E M
authors.initials: EM
authors.lastname: Kallergis
authors.forename: E G
authors.initials: EG
authors.lastname: Manios
authors.forename: E M
authors.initials: EM
authors.lastname: Kanoupakis
authors.forename: H E
authors.initials: HE
authors.lastname: Mavrakis
authors.forename: S G
authors.initials: SG
authors.lastname: Kolyvaki
authors.forename: G M
authors.initials: GM
authors.lastname: Lyrarakis
authors.forename: G I
authors.initials: GI
authors.lastname: Chlouverakis
authors.forename: P E
authors.initials: PE
authors.lastname: Vardas
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000097:blood / Q000209:etiology*; D002097:C-Reactive Protein / Q000378:metabolism*; D002908:Chronic Disease; D004554:Electric Countershock; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000097:blood / Q000150:complications*; D011446:Prospective Studies; D012008:Recurrence
chemical_list: D002097:C-Reactive Protein