Gurses Kadri Murat, Kocyigit Duygu, Yalcin Muhammed Ulvi, Canpinar Hande, Yorgun Hikmet, Sahiner Mehmet Levent, Kaya Ergun Baris, Oto Mehmet Ali, Ozer Necla, Guc Dicle, Aytemir Kudret
Department of Cardiology, Konya Training and Research Hospital, Konya, Turkey.
Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Am J Cardiol. 2016 May 1;117(9):1463-7. doi: 10.1016/j.amjcard.2016.02.014. Epub 2016 Feb 17.
Atrial fibrillation (AF) is the most common sustained arrhythmia. Inflammation has been suggested to play a vital role in the pathogenesis. Previous studies have investigated expression of inflammatory markers in AF. Several studies have focused on the effects of toll-like receptors (TLRs) on heart in terms of capability of modulating inflammation. In this study, we aimed to investigate whether peripheral monocyte TLR expression was associated with the AF presence, and recurrence of AF after cryoablation, as a reflection of inflammatory status. Patients with AF who were scheduled for cryoballoon-based ablation for AF and age- and gender-matched subjects in sinus rhythm were included. Peripheral monocyte TLR-2 and TLR-4 expressions were evaluated by flow cytometric analysis in peripheral venous blood samples obtained during evaluation in outpatient clinics: 172 patients (56.5 ± 6.6 years, 52.3% men) were included in the study. Peripheral monocyte TLR-2 and TLR-4 expression levels were significantly higher in patients with AF (p <0.05). Among patients with AF, 12 patients (14.0%) developed AF recurrence at a follow- up of 17 months. Multivariate Cox regression analysis showed that left atrial volume index (hazard ratio 2.040, 95% CI 1.197 to 3.477, p = 0.009) and monocyte TLR-4 expression (hazard ratio 1.226, 95% CI 1.042 to 1.443, p = 0.014) were independent predictors of AF recurrence after blanking period following second-generation cryoballoon-based pulmonary vein isolation for paroxysmal AF. In conclusion, our study highlights the role of TLR-mediated inflammation in the pathogenesis of AF. This link may also constitute a therapeutic target in patients with AF.
心房颤动（AF）是最常见的持续性心律失常。炎症被认为在其发病机制中起着至关重要的作用。既往研究已对AF中炎症标志物的表达进行了调查。有几项研究聚焦于Toll样受体（TLRs）在调节炎症能力方面对心脏的影响。在本研究中，我们旨在调查外周血单核细胞TLR表达是否与AF的存在以及冷冻消融术后AF的复发相关，以此反映炎症状态。纳入了计划接受基于冷冻球囊的AF消融术的AF患者以及年龄和性别匹配的窦性心律受试者。通过流式细胞术分析在门诊评估期间采集的外周静脉血样本，评估外周血单核细胞TLR-2和TLR-4的表达：172例患者（年龄56.5±6.6岁，男性占52.3%）纳入研究。AF患者外周血单核细胞TLR-2和TLR-4表达水平显著更高（p<0.05）。在AF患者中，12例患者（14.0%）在17个月的随访中发生AF复发。多因素Cox回归分析显示，左心房容积指数（风险比2.040，95%可信区间1.197至3.477，p=0.009）和单核细胞TLR-4表达（风险比1.226，95%可信区间1.042至1.443，p=0.014）是第二代基于冷冻球囊的肺静脉隔离治疗阵发性AF后空白期AF复发的独立预测因素。总之，我们的研究突出了TLR介导的炎症在AF发病机制中的作用。这种联系也可能构成AF患者的一个治疗靶点。
