Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Am J Cardiol. 2010 Feb 15;105(4):495-501. doi: 10.1016/j.amjcard.2009.10.019. Epub 2010 Jan 5.
Previous studies have reported that increased high-sensitive C-reactive protein (hs-CRP) levels are associated with an inflammatory state. This study investigated the association among hs-CRP, substrate properties, and long-term clinical outcomes after catheter ablation of atrial fibrillation (AF). A total of 137 patients with AF (54 +/- 13 years) who underwent mapping and catheter ablation were included. The hs-CRP was measured before the first ablation procedure. The substrate properties (initiating triggers, biatrial mean voltage, and high-frequency sites) of the 2 atria and long-term outcome were investigated in patients in the low hs-CRP group (<75%, 2.92 mg/L) and high hs-CRP group (>75%, 2.92 mg/L). Patients with a higher hs-CRP were associated with an increased number of identified nonpulmonary vein ectopies (34.4% vs 17%, p = 0.034), lower mean left atrial (LA) voltage (1.72 +/- 0.73 vs 1.92 +/- 0.72 Hz, p = 0.045), and higher-frequency sites in the left atrium (71% vs 37%, p = 0.027). After a median follow-up period of 15 months, the single-procedure success rate (72% vs 53%, p = 0.008) and final success rate after multiple procedures (94% vs 81%, p = 0.02) were higher in the low hs-CRP group. In a multivariable regression model adjusted for other potential covariates, hs-CRP level (p = 0.021) and LA diameter (p = 0.032) were independent predictors of recurrence. In conclusion, baseline CRP levels before the first AF ablation procedure had an independent prognostic value in predicting long-term recurrence. Patients with a high hs-CRP level were associated with an abnormal LA substrate and high incidence of nonpulmonary vein AF sources.
先前的研究报告指出，高敏 C 反应蛋白（hs-CRP）水平升高与炎症状态有关。本研究旨在探讨 hs-CRP 与底物特性以及房颤（AF）导管消融后的长期临床结局之间的关系。共纳入 137 例接受 AF 标测和导管消融的患者（54±13 岁）。hs-CRP 在首次消融术前进行测量。在 hs-CRP 低水平组（<75%，2.92mg/L）和高水平组（>75%，2.92mg/L）中，对患者的心房底物特性（起始触发、双心房平均电压和高频部位）和长期结局进行了研究。hs-CRP 较高的患者与识别出的非肺静脉异位灶数量增多有关（34.4% vs 17%，p=0.034），左心房（LA）平均电压较低（1.72±0.73 vs 1.92±0.72Hz，p=0.045），左心房高频部位比例较高（71% vs 37%，p=0.027）。在中位随访 15 个月后，hs-CRP 低水平组的单次手术成功率（72% vs 53%，p=0.008）和多次手术后的最终成功率（94% vs 81%，p=0.02）更高。在校正其他潜在混杂因素后，hs-CRP 水平（p=0.021）和 LA 直径（p=0.032）是预测复发的独立预测因素。总之，首次 AF 消融术前的 CRP 基线水平对预测长期复发具有独立的预后价值。hs-CRP 水平较高的患者与 LA 底物异常和非肺静脉 AF 源的高发生率相关。
