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(Circulation. 2003;108:2446.)
© 2003 American Heart Association, Inc.

Brief Rapid Communications

Effect of Atrial Fibrillation on Hematopoietic Progenitor Cells

A Novel Pathophysiological Role of the Atrial Natriuretic Peptide?

Andreas Goette, MD^*; Kathleen Jentsch-Ullrich, MD^*; Uwe Lendeckel, PhD; Christoph Röcken, MD; Mahmood Agbaria, MS; Angelo Auricchio, MD; Martin Mohren, MD; Astrid Franke, MD; Helmut U. Klein, MD

From University Hospital Magdeburg, Division of Cardiology (A.G., M.A., A.A., H.U.K.), Institute of Experimental Internal Medicine (U.L., C.R), Division of Hematology/Oncology (M.M., K.J.U., A.F.), Magdeburg, Germany.

Correspondence to Andreas Goette, MD, University Hospital Magdeburg, Division of Cardiology, Leipziger Str 44, 39120 Magdeburg, Germany. E-mail andreas.goette{at}medizin.uni-magdeburg.de

Received August 8, 2003; revision received September 26, 2003; accepted September 26, 2003.

Background— Injury to the heart causes hematopoietic progenitor cells (HPCs) to migrate to the site of damage and to undergo cell differentiation. Studies suggest that myocardial progenitor cells invade atrial tissue. So far it is unclear, however, whether an atrial disease per se affects circulating HPCs.

Methods and Results— Seventeen patients with persistent atrial fibrillation (persistAF), 12 with paroxysmal AF (paroxAF), and 17 matched patients with sinus rhythm (SR) were studied. HPCs (CD34⁺ and CD34⁺/CD117⁺) were quantified with the use of a fluorescence-activated cell sorter; stromal cell–derived factor-1 (SDF-1), vascular endothelium growth factor (VEGF), and atrial natriuretic peptide (ANP) were determined by immunoassays. In patients with persistAF, blood samples were obtained before as well as 10 minutes, 24 hours, and 48 hours after electrical cardioversion. CD34⁺HPCs (AF, 7.0±2.3x103/mL versus SR, 5.0±1.6x10³/mL; P<0.01) were increased during persistAF only. Highest SDF-1 levels were also observed during persistAF. Successful and unsuccessful cardioversion decreased CD34⁺HPCs temporarily (7.0±2.3x10³/mL versus 24 hours: 5.0±1.5x10³/mL; P<0.05). Forty-eight hours after successful cardioversion, SDF-1 and CD34⁺HPC levels started to decline, reaching control levels after 59±19 days. CD34⁺/CD117⁺ and VEGF levels, however, were increased by DC energy but not by AF. ANP levels correlated with CD34⁺HPC (r=0.76; P<0.01) and SDF-1 (r=0.56; P<0.01). HPCs from patients with AF had a greater tendency to differentiate into cells expressing (cardio)myocyte markers ANP and myocyte enhancer factor-2.

Conclusions— PersistAF appears to increase the potential of HPCs for (cardio)myogenesis. Restitution of CD34⁺HPC levels, mediated by SDF-1 and possibly ANP, occurs within several weeks after successful cardioversion.

Key Words: arrhythmia • blood cells • cardioversion • fibrillation • natriuretic peptides

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