Letsas Konstantinos P, Weber Reinhold, Bürkle Gerd, Mihas Constantinos C, Minners Jan, Kalusche Dietrich, Arentz Thomas
Arrhythmia Service, Herz-Zentrum, Bad Krozingen, Germany.
Europace. 2009 Feb;11(2):158-63. doi: 10.1093/europace/eun309. Epub 2008 Nov 13.
An increasing body of evidence has demonstrated the essential role of inflammation in the genesis and maintenance of atrial fibrillation (AF). The aim of the present study was to investigate whether success or failure of electrical pulmonary vein isolation (PVI) in patients with AF is related with the presence of a pre-ablative inflammatory state as determined by known clinical parameters and conventional markers of inflammation including high-sensitivity C-reactive protein, white blood cell (WBC) count, and fibrinogen.
Seventy-two patients with paroxysmal (64%) or persistent AF (36%) underwent successful electrical PVI. The mean duration of arrhythmia was 5.5 +/- 2.9 years. After a mean follow-up period of 12.5 +/- 5.7 months, 44 patients (61%) were in sinus rhythm. In univariate Cox proportional hazard regression analysis, hypertension, body mass index (BMI), left ventricular ejection fraction, left ventricular end-diastolic diameter, left atrial diameter (LAD), WBC count, and high-sensitivity C-reactive protein were significantly associated with AF recurrence (P < 0.05). In multivariate Cox proportional hazard regression analysis, hypertension [hazard ratio (HR) 3.127; 95% confidence interval (CI) 1.269-7.706, P = 0.013], LAD (HR 1.077; 95% CI 1.014-1.144, P = 0.015), and WBC count (HR 1.423; 95% CI 1.067-1.897, P = 0.016) were independent pre-ablative predictors of AF recurrence following PVI.
Conventional markers of the inflammatory cascade such as WBC count and high-sensitivity C-reactive protein as well as elements of the metabolic syndrome such as hypertension and increased BMI were significantly associated with AF recurrence. The impact of a pre-ablative inflammatory state in the overall success rate of PVI needs further elucidation.
越来越多的证据表明炎症在心房颤动（AF）的发生和维持中起着至关重要的作用。本研究的目的是调查房颤患者肺静脉电隔离（PVI）的成功或失败是否与消融前炎症状态的存在有关，该炎症状态由已知临床参数和炎症的传统标志物（包括高敏C反应蛋白、白细胞（WBC）计数和纤维蛋白原）确定。
72例阵发性（64%）或持续性房颤（36%）患者成功接受了肺静脉电隔离。心律失常的平均持续时间为5.5±2.9年。平均随访12.5±5.7个月后，44例患者（61%）维持窦性心律。在单因素Cox比例风险回归分析中，高血压、体重指数（BMI）、左心室射血分数、左心室舒张末期直径、左心房直径（LAD）、白细胞计数和高敏C反应蛋白与房颤复发显著相关（P<0.05）。在多因素Cox比例风险回归分析中，高血压[风险比（HR）3.127；95%置信区间（CI）1.269 - 7.706，P = 0.013]、LAD（HR 1.077；95%CI 1.014 - 1.144，P = 0.015）和白细胞计数（HR 1.423；95%CI 1.067 - 1.897，P = 0.016）是肺静脉隔离术后房颤复发的独立消融前预测因素。
炎症级联反应的传统标志物如白细胞计数和高敏C反应蛋白以及代谢综合征的要素如高血压和BMI增加与房颤复发显著相关。消融前炎症状态对肺静脉隔离总体成功率的影响需要进一步阐明。
