Liu Jun, Fang Pi-Hua, Dibs Samer, Hou Yu, Li Xiao-Feng, Zhang Shu
Center for Arrhythmia Diagnosis and Treatment, Fu Wai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.
Pacing Clin Electrophysiol. 2011 Apr;34(4):398-406. doi: 10.1111/j.1540-8159.2010.02978.x. Epub 2010 Nov 22.
Atrial fibrillation (AF) recurrence after circumferential pulmonary vein isolation (CPVI) is difficult to predict. Inflammation is associated with the development of AF. Inflammatory markers, such as high sensitivity C-reactive protein (hsCRP), are related to AF development via atrial remodeling. However, it is unknown whether plasma hsCRP concentration before CPVI can be used as a predictor for AF recurrence.
A total of 121 patients without structural heart disease who underwent primary CPVI by a single operator were included in the study (paroxysmal/persistent AF: 77/44). Left atrial diameter was measured by transesophageal echocardiography. Plasma hsCRP concentration was determined by enzyme-linked immunosorbent assay. Based on the follow-up outcomes, patients were divided into two groups, a recurrence group and a nonrecurrence group. AF recurrence was defined as AF or atrial flutter or atrial tachycardia episodes lasting for ≥30 s during regular follow-up (>12 months).
A total of 36 (29.8%) patients (paroxysmal/persistent AF: 19 [24.7%]/17 [38.6%]) had AF recurrence in a mean 23 (range, 12-44) month follow-up period. The plasma hsCRP concentration in the recurrence group was significantly higher than that in the nonrecurrence group for all patients (median [quartile range] 2.22 [1.97] mg/L vs 0.89 [1.30] mg/L, P < 0.001), for patients with paroxysmal AF (2.12 [2.78] mg/L vs 0.84 [1.15] mg/L, P = 0.028), and for those with persistent AF (2.29 [1.08] mg/L vs 0.89 [1.53] mg/L, P = 0.005). Multiple logistic regression analyses showed that the higher level of the plasma hsCRP (P < 0.001) was a significant prognostic predictor of AF recurrence, both for patients with paroxysmal AF (P = 0.012) and those with persistent AF (P = 0.003).
Plasma hsCRP concentration before CPVI was associated with AF recurrence after primary CPVI procedure for both paroxysmal and persistent AF patients. Plasma hsCRP concentration could play a role in prediction of AF recurrence after primary CPVI.
环肺静脉隔离术（CPVI）后房颤（AF）复发难以预测。炎症与房颤的发生有关。炎症标志物，如高敏C反应蛋白（hsCRP），通过心房重构与房颤的发生相关。然而，CPVI术前血浆hsCRP浓度是否可作为房颤复发的预测指标尚不清楚。
本研究纳入了121例无结构性心脏病且由单一术者进行首次CPVI的患者（阵发性/持续性房颤：77/44例）。经食管超声心动图测量左心房直径。采用酶联免疫吸附测定法测定血浆hsCRP浓度。根据随访结果，将患者分为两组，复发组和未复发组。房颤复发定义为在规律随访（>12个月）期间房颤或房扑或房性心动过速发作持续≥30秒。
在平均23（范围12 - 44）个月的随访期内，共有36例（29.8%）患者发生房颤复发（阵发性/持续性房颤：19例[24.7%]/17例[38.6%]）。所有患者中，复发组的血浆hsCRP浓度显著高于未复发组（中位数[四分位数间距]2.22[1.97]mg/L对0.89[1.30]mg/L，P<0.001），阵发性房颤患者中（2.12[2.78]mg/L对0.84[1.15]mg/L，P = 0.028），持续性房颤患者中（2.29[1.08]mg/L对0.89[1.53]mg/L，P = 0.005）。多因素logistic回归分析显示，较高水平的血浆hsCRP（P<0.001）是房颤复发的显著预后预测指标，无论是阵发性房颤患者（P = 0.012）还是持续性房颤患者（P = 0.003）。
对于阵发性和持续性房颤患者，CPVI术前血浆hsCRP浓度与首次CPVI术后房颤复发相关。血浆hsCRP浓度可能在预测首次CPVI术后房颤复发中发挥作用。
