Protracted CRP elevation after atrial fibrillation ablation.
BACKGROUND
Atrial fibrillation (AF) has been linked to an inflammatory process detected through various biomarkers, including C-Reactive Protein (CRP). Early recurrence of AF within the first 3 months after curative AF ablation is not felt to reflect success or failure of the procedure. We hypothesized that this early recurrence is due to an inflammatory response to the ablation itself. We therefore sought to evaluate levels of CRP after AF ablation.


METHODS
We prospectively enrolled subjects undergoing AF ablation. A control group of patients undergoing ablation for supraventricular tachycardia (SVT) was also enrolled. Each patient had CRP drawn on the day of the procedure (prior to ablation) and during their first follow-up (median 49 days, interquartile range [IQR] 37-93) and second follow-up (median 147 days, IQR 141-257) clinic visits. Patient interviews were performed and medical histories reviewed for evidence of recurrent AF prior to the first follow-up.


RESULTS
CRP levels significantly increased from baseline to first follow-up in the AF ablation group (P = 0.0017). CRP did not significantly change after SVT ablation (P = 0.92). Seventeen (45%) of the AF subjects exhibited recurrence of AF prior to first follow-up. After adjusting for multiple potential confounders, AF ablation patients with recurrent AF prior to their first follow-up had a statistically significant greater odds of having an increase in CRP (OR 21, 95% CI 1.1-417, P = 0.045).


CONCLUSIONS
AF ablation generates an inflammatory response that persists for several weeks. This inflammation may explain early recurrence of AF after curative ablation.
Division of Cardiology, Electrophysiology Section, University of California, San Francisco, California, USA.
James M
JM
McCabe
Lisa M
LM
Smith
Zian H
ZH
Tseng
Nitish
N
Badhwar
Byron K
BK
Lee
Randall J
RJ
Lee
Melvin M
MM
Scheinman
Jeffrey E
JE
Olgin
Gregory M
GM
Marcus
D001281:Atrial Fibrillation / Q000097:blood* / Q000209:etiology / Q000601:surgery*; D002097:C-Reactive Protein / Q000032:analysis*; D017115:Catheter Ablation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000097:blood* / Q000209:etiology*; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome
D002097:C-Reactive Protein