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CLINICAL RESEARCH: HEART RHYTHM DISORDER

High Sensitivity C-Reactive Protein

A Novel Predictor for Recurrence of Atrial Fibrillation After Successful Cardioversion

Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota

Manuscript received March 24, 2005; revised manuscript received May 28, 2005, accepted June 6, 2005.

^_* Reprint requests and correspondence: Dr. Virend K. Somers, Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905. (Email: somers.virend{at}mayo.edu).

OBJECTIVES: We sought to test the hypothesis that C-reactive protein (CRP) can predict the recurrence of atrial fibrillation (AF) after successful electrical cardioversion (CV).

BACKGROUND: In patients with AF, CRP levels are predictive of immediate failure of CV.

METHODS: We prospectively measured high-sensitivity CRP in 67 patients with AF or atrial flutter who underwent successful electrical CV.

RESULTS: At one-month follow-up, 22 patients (33%) had recurrence of their arrhythmia. Arrhythmia recurrence was associated with significantly higher pre-CV CRP levels (odds ratio [OR] 1.84; 95% confidence interval [CI] 1.14 to 2.98; p = 0.013) even after adjusting for age (OR 2.22; 95% CI 1.25 to 3.93; p = 0.006), for gender (OR 1.89; 95% CI 1.16 to 3.09; p = 0.011), or duration of arrhythmia (OR 1.86; 95% CI 1.13 to 3.07; p = 0.015). On multivariate analysis, CRP was the only independent predictor of arrhythmia recurrence (OR 2.19; 95% CI 1.05 to 4.55; p = 0.036).

CONCLUSIONS: Our data suggest that high levels of CRP are associated with an increased risk of recurrence of AF within one month. These data support the hypothesis that anti-inflammatory interventions may help in maintenance of normal sinus rhythm after CV. These data also may have implications for the identification of patients who are most likely to experience substantial benefit from CV therapy for AF.

Abbreviations and Acronyms   AF = atrial fibrillation   BB = beta blockers   CCB = calcium channel blockers   CI = confidence interval   CRP = C-reactive protein   CV = cardioversion   OR = odds ratio

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