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. 2008 Feb;5(2):215-21.
doi: 10.1016/j.hrthm.2007.10.007. Epub 2007 Oct 7.

Markers of inflammation before and after curative ablation of atrial flutter

Gregory M Marcus  1 , Lisa M Smith, David V Glidden, Emily Wilson, Jamie M McCabe, Dean Whiteman, Zian H Tseng, Nitish Badhwar, Byron K Lee, Randall J Lee, Melvin M Scheinman, Jeffrey E Olgin
Affiliations

Markers of inflammation before and after curative ablation of atrial flutter

Gregory M Marcus et al. Heart Rhythm. 2008 Feb.

Abstract

Background: Atrial arrhythmias are associated with inflammation. The cause and effect of the association are unknown.

Objective: The purpose of this study was to test the hypothesis that atrial tachyarrhythmias contribute to inflammation.

Methods: We performed a prospective observational study wherein C-reactive protein (CRP) and interleukin-6 (IL-6) levels from the femoral vein and coronary sinus (CS) were compared before curative ablation for atrial flutter (AFL; n = 59) and paroxysmal supraventricular tachycardia (SVT; n = 110). Follow-up levels were obtained at 1 and 6 months.

Results: Peripheral levels of both biomarkers were significantly higher in the AFL group. After multivariate adjustment, only those in the AFL group who presented in AFL or atrial fibrillation (AF) had significantly elevated CRP levels (odds ratio 1.26; P = .033). Levels of each marker were similar in the CS and peripheral blood in the SVT group; in the AFL group, both CRP and IL-6 were significantly lower in the CS than in the periphery (P = .0076 and P = .0021, respectively). CRP was significantly lower a median of 47 days after AFL ablation (from a median of 6.28 mg/L to a median of 2.92 mg/L; P = .028) and remained reduced at second follow-up. IL-6 decreased across three time points after AFL ablation (P = .002). No reduction in inflammatory biomarkers was observed after SVT ablation.

Conclusions: CRP and IL-6 levels are elevated in patients presenting in AFL. Given the lower CS values in these patients, their origin appears to be systemic rather than cardiac. Because these levels significantly fall after ablation of AFL, the atrial tachyarrhythmia appears to be the cause (not the effect) of the inflammation.

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Conflict of interest statement

Disclosures/potential conflicts of interest: None

Figures

Figure 1
Figure 1
Baseline serologic markers of inflammation (left) in those with atrial flutter (AFL) and supraventricular tachycardia (SVT). On the right, AFL patients that presented in AFL (n=32) or atrial fibrillation (AF, n=1) are compared to the AFL patients that presented in normal sinus rhythm (NSR, n=26). Y error bars denote interquartile ranges.
Figure 2
Figure 2
Levels of CRP and IL-6 are each significantly lower in the coronary sinus than the femoral vein in the atrial flutter (AFL) patients (n=37); no significant differences are seen in the supraventricular tachycardia (SVT) patients (n=59). Y error bars denote interquartile ranges.
Figure 3
Figure 3
Change in each marker after ablation in the atrial flutter group and the supraventricular tachycardia group. Data for those with first follow-up is shown in solid lines, and data for those with second follow-up is shown in dashed lines. All subjects with second follow-up also had first follow-up. One subject in the AFL group developed a recurrence of AFL (included in the first follow-up data). The asterix (*) denotes a significant decline in marker level with p<0.05. Y error bars denote interquartile ranges.
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Comment in

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