Intracardiac and extracardiac markers of inflammation during atrial fibrillation

被引:130
作者
Marcus, Gregory M. [1 ]
Smith, Lisa M. [1 ]
Ordovas, Karen [2 ]
Scheinman, Melvin M. [1 ]
Kim, Albert M. [1 ]
Badhwar, Nitish [1 ]
Lee, Randall J. [1 ]
Tseng, Zian H. [1 ]
Lee, Byron K. [1 ]
Olgin, Jeffrey E. [1 ]
机构
[1] Univ Calif San Francisco, Div Cardiol, Electrophysiol Sect, San Francisco, CA 94143 USA
[2] Univ Calif San Francisco, Dept Radiol & Biomed Imaging, San Francisco, CA 94143 USA
基金
美国国家卫生研究院;
关键词
Atrial fibrillation; Coronary sinus; C-reactive protein; Inflammation; Interleukin-6; Left atrium; C-REACTIVE PROTEIN; INTERLEUKIN-6; LEVELS; PERSISTENCE; MONOCYTES; FLUTTER; CELLS;
D O I
10.1016/j.hrthm.2009.10.004
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND A decrease in inflammation after cure of atrial arrhythmias suggests that such arrhythmias are proinflammatory, and lower inflammatory marker levels in the coronary sinus suggest that atrial arrhythmias result in intracardiac appropriation of inflammatory cytokines. OBJECTIVE The purpose of this study was to investigate the effect of atrial fibrillation on inflammatory markers drawn from intracardiac and extracardiac chambers. METHODS We performed a case-control study of 167 AF patients and 207 controls. Blood from intracardiac and extracardiac sites was obtained from a subset of patients undergoing curative AF ablation (n = 46). RESULTS No significant differences in C-reactive protein (CRP) or interleukin-6 (IL-6) levels were seen between patients with and those without a history of AF. Both levels were significantly higher when blood was drawn during AF than during sinus rhythm: median CRP 3.1 mg/dL (interquartile range [IQR] 1.0-6.0) versus 1.7 mg/dL (IQR 0.7-3.9, P = .0005); median IL-6 2.3 ng/mL (IQR 1.5-3.9) versus 1.5 ng/mL (IQR 0.7-2.5, P = .007). This finding persisted after adjusting for potential confounders. AF ablation patients in AF exhibited a positive median left atrial minus coronary sinus gradient CRP (0.3 mg/dL, IQR -0.03-1.1), whereas those in sinus rhythm had a negative median left atrial minus coronary sinus gradient CRP (-0.2, IQR -0.8-[-0.02], P = .01). Femoral artery minus femoral vein gradients in AF versus sinus rhythm did not show any differences. CONCLUSION AF at the time of the blood draw, rather than a history of AF, was independently associated with inflammation. Differences in transcardiac gradients suggest that AF results in sequestration of inflammatory cytokines in the heart.
引用
收藏
页码:149 / 154
页数:6
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