Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
Europace. 2012 Jun;14(6):810-7. doi: 10.1093/europace/eur402. Epub 2012 Jan 10.
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.
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.
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.
由于房颤（AF）的发生和维持涉及多种机制，节律控制的转复效果仍然较差。AF 复发时间的差异可能取决于不同类型的机制。本研究旨在评估短程 AF 患者早期 AF 复发的相关机制。
纳入了 100 例短程持续性 AF 行节律控制的患者。评估了与 AF 发生和维持相关的机制标志物，包括临床因素、超声心动图参数和生物标志物。主要终点是早期 AF 复发（<1 个月复发）。次要终点是进展为永久性 AF。中位总 AF 病史较短：4.2 个月。30 例患者（30%）在中位 6（2-14 四分位间距）天后发生早期 AF 复发。基线白细胞介素（IL）-6 的对数（2）[校正后的危险比（HR）为 1.3，95%置信区间（CI）为 1.0-1.7，P=0.02]和目前或既往吸烟（校正 HR 为 3.6，95%CI 为 1.2-10.9，P=0.03）与早期 AF 复发独立相关，表明炎症在早期复发中发挥了重要作用。29 例患者（29%）AF 转为永久性。基线转化生长因子-β1、左心室射血分数和早期 AF 复发与进展为永久性 AF 独立相关。
在短程 AF 患者中，早期 AF 复发似乎与 IL-6 等炎症相关。因此，针对炎症的治疗可能可以预防早期 AF 复发，从而改善节律控制效果。
