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CLINICAL STUDY: ELECTROPHYSIOLOGIC DISORDERS

Expression of angiotensin II receptors in human left and right atrial tissue in atrial fibrillation with and without underlying mitral valve disease

Andreas Boldt, MSc^*,*, Ulrike Wetzel, MD, Josef Weigl, Jens Garbade, MD^*, Jörg Lauschke, Gerhard Hindricks, MD, Hans Kottkamp, MD, Jan Fritz Gummert, MD^* and Stefan Dhein, MD^*

^* University of Leipzig, Heart Center, Cardiovascular Surgery, Cardiology, Leipzig, Germany
Department of Electrophysiology, Leipzig, Germany

^* Reprint requests and correspondence: Andreas Boldt, University of Leipzig, Heart Center, Cardiovascular Surgery, Strümpellstrasse 19, D-04289, Leipzig, Germany.
AndreasBoldt{at}web.de

OBJECTIVES: We postulated a change of angiotensin II receptor subtype expression in patients with lone atrial fibrillation (AF) and AF with underlying mitral valve disease (MVD) both compared with sinus rhythm (SR).

BACKGROUND: Atrial fibrillation is a progressive disease associated with electrical and structural remodeling. Angiotensin II (ANGII) is involved in the process of myocardial remodeling. Actions of ANGII are mediated by ANGII receptor subtypes 1 and 2 (AT₁ and AT₂).

METHODS: Left atrial (LA) and right atrial (RA) tissue samples were obtained from patients with AF or SR with or without underlying MVD. The AT₁ and AT₂ protein levels were measured by quantitative Western blotting techniques.

RESULTS: The AT₁ protein level in the LA was significantly increased in patients with AF (all forms) compared with SR (p < 0.05), whereas AT₂ expression was not significantly altered. Comparison of the subgroups revealed a similar increase of AT₁ in both paroxysmal AF and chronic AF with or without MVD. Additionally, investigations of ANGII receptor subtypes in the RA did not exhibit any significant changes either in AT₁ or in AT₂ in patients with AF versus SR. Underlying MVD did not significantly affect AT₂ receptor subtype expression in LA.

CONCLUSIONS: Atrial fibrillation is associated with an up-regulation of AT₁ in LA, but not in RA, and did not appear to influence the AT₂ expression in the atrium. Because we found an enhanced expression of AT₁in the LA, we conclude that AT₁ might be involved in the pathogenesis of AF in the LA.

Abbreviations and Acronyms   AF = atrial fibrillation   ANGII = angiotensin II   ANOVA = analysis of variance   AT1 = angiotensin II receptor type 1   AT2 = angiotensin II receptor type 2   CAF = chronic atrial fibrillation   CHF = congestive heart failure   GAPDH = glyceralaldehyde-3-phosphate dehydrogenase   LA = left atrial/atrium   LV = left ventricular   MVD = mitral valve disease   PAF = paroxysmal atrial fibrillation   RA = right atrial/atrium   SR = sinus rhythm

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