title: Serum levels of vitamin E are associated with early recurrence of atrial fibrillation after electric cardioversion.
abstract: BACKGROUND
  Oxidative stress is suggested to play a role in favoring the occurrence of atrial fibrillation (AF). We analyzed whether vitamin E, a known antioxidant, or markers of oxidative stress are associated with AF recurrence in patients undergoing electric cardioversion.
  
  
  RESULTS
  A total of 144 patients (83 men; mean age, 71.1±5.4 years) underwent successful biphasic electric cardioversion of nonvalvular persistent AF. At baseline, urinary 8-isoprostaglandin F2α and serum soluble NOX2-derived peptide (sNOX2-dp), high-sensitivity C-reactive protein (hs-CRP), and vitamin E levels were measured in each patient. All patients underwent 3 months of clinical follow-up, including an office visit with ECG every week or in cases of symptom recurrence. During the follow-up, 94 patients maintained sinus rhythm, whereas 50 experienced AF recurrence. In unadjusted analysis, left atrial diameter and levels of urinary isoprostanes and serum sNOX2-dp and hs-CRP were significantly higher and serum vitamin E lower in patients with AF recurrence. In multivariable Cox analysis, serum vitamin E (hazard ratio, 0.734; 95% CI, 0.605-0.891; P<0.001) and, to a lesser extent, hs-CRP (P=0.047) remained significantly associated with AF recurrence. Urinary isoprostanes and serum sNOX2-dp levels were inversely correlated with serum vitamin E level (r=-0.626, P<0.001, and r=-0.460, P<0.001, respectively).
  
  
  CONCLUSIONS
  The study shows that low serum vitamin E levels are associated with AF recurrence in patients who underwent cardioversion. Because vitamin E inversely correlated with oxidative stress, the findings reinforce the hypothesis of an interplay between oxidative stress and AF.
authors.affiliation: I Clinica Medica, Sapienza University of Rome, Rome, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Ferro
authors.forename: Pasquale
authors.initials: P
authors.lastname: Franciosa
authors.forename: Roberto
authors.initials: R
authors.lastname: Cangemi
authors.forename: Roberto
authors.initials: R
authors.lastname: Carnevale
authors.forename: Pasquale
authors.initials: P
authors.lastname: Pignatelli
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Loffredo
authors.forename: Ludovica
authors.initials: L
authors.lastname: Perri
authors.forename: Elisa
authors.initials: E
authors.lastname: Catasca
authors.forename: Francesco
authors.initials: F
authors.lastname: Violi
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000628:therapy*; D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D015237:Dinoprost / Q000031:analogs & derivatives / Q000652:urine; D004554:Electric Countershock; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008562:Membrane Glycoproteins / Q000097:blood; D000074662:NADPH Oxidase 2; D019255:NADPH Oxidases / Q000097:blood; D018384:Oxidative Stress / Q000502:physiology; D012008:Recurrence; D012189:Retrospective Studies; D014810:Vitamin E / Q000097:blood*
chemical_list: D015415:Biomarkers; D008562:Membrane Glycoproteins; D014810:Vitamin E; C075750:8-epi-prostaglandin F2alpha; D002097:C-Reactive Protein; D015237:Dinoprost; C056558:CYBB protein, human; D000074662:NADPH Oxidase 2; D019255:NADPH Oxidases