title: Role of inflammation in early atrial fibrillation recurrence.
abstract: OBJECTIVE
  Outcome of rhythm control in atrial fibrillation (AF) is still poor due to various mechanisms involved in the initiation and perpetuation of AF. Differences in timing of AF recurrence may depend on different types of mechanisms. The aim of this study was to assess the mechanisms involved in early AF recurrence in patients with short-lasting AF.
  
  
  RESULTS
  Patients with short-lasting persistent AF undergoing rhythm control (n= 100) were included. Markers of mechanisms involved in the initiation and perpetuation of AF were assessed, including clinical factors, echocardiographic parameters, and biomarkers. Primary endpoint was early AF recurrence (recurrence <1 month). Secondary endpoint was progression to permanent AF. Median total AF history was short: 4.2 months. Early AF recurrences occurred in 30 patients (30%) after a median of 6 (inter-quartile range 2-14) days. Baseline log(2) interleukin (IL)-6 [adjusted hazard ratio (HR) 1.3, 95% confidence interval (CI) 1.0-1.7, P= 0.02] and present or previous smoking (adjusted HR 3.6, 95% CI 1.2-10.9, P= 0.03) were independently associated with early AF recurrence, suggesting that inflammation played an important role in early recurrences. Atrial fibrillation became permanent in 29 patients (29%). Baseline transforming growth factor-β1, left ventricular ejection fraction, and early AF recurrence were independently associated with progression to permanent AF.
  
  
  CONCLUSIONS
  In patients with short-lasting AF, early AF recurrence seemed to be associated with inflammation as represented by IL-6. Treatment aimed against inflammation may therefore prevent early AF recurrences, which can improve rhythm control outcome.
authors.affiliation: Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands. m.d.smit@umcg.nl
authors.forename: Marcelle D
authors.initials: MD
authors.lastname: Smit
authors.forename: Alexander H
authors.initials: AH
authors.lastname: Maass
authors.forename: Anne Margreet
authors.initials: AM
authors.lastname: De Jong
authors.forename: Anneke C
authors.initials: AC
authors.lastname: Muller Kobold
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Van Veldhuisen
authors.forename: Isabelle C
authors.initials: IC
authors.lastname: Van Gelder
mesh_terms: D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000276:immunology* / Q000517:prevention & control*; D015415:Biomarkers / Q000097:blood; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015850:Interleukin-6 / Q000097:blood / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000276:immunology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D014463:Ultrasonography
chemical_list: D000893:Anti-Inflammatory Agents; D015415:Biomarkers; C508600:IL6 protein, human; D015850:Interleukin-6