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(Circulation. 2001;104:2886.)
© 2001 American Heart Association, Inc.

Clinical Investigation and Reports

C-Reactive Protein Elevation in Patients With Atrial Arrhythmias

Inflammatory Mechanisms and Persistence of Atrial Fibrillation

Mina K. Chung, MD; David O. Martin, MD, MPH; Dennis Sprecher, MD; Oussama Wazni, MD; Anne Kanderian, MD; Cynthia A. Carnes, PharmD, PhD; John A. Bauer, PhD; Patrick J. Tchou, MD; Mark J. Niebauer, MD; Andrea Natale, MD; David R. Van Wagoner, PhD

From the Department of Cardiovascular Medicine, the Cleveland Clinic Foundation, Cleveland, Ohio (M.K.C., D.O.M., D.S., O.W., A.K., P.J.T., M.J.N., A.N., D.R.V.W.) and the College of Pharmacy and the Dorothy M. Davis Heart and Lung Research Institute, Ohio State University, Columbus, Ohio (J.A.B., C.A.C.).

Correspondence to Mina K. Chung, MD, Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, 9500 Euclid Avenue, F-15, Cleveland, OH 44195. E-mail chungm{at}ccf.org

Background— Atrial fibrillation (AF) may persist due to structural changes in the atria that are promoted by inflammation. C-reactive protein (CRP), a marker of systemic inflammation, predicts cardiovascular events and stroke, a common sequela of AF. We hypothesized that CRP is elevated in patients with atrial arrhythmias.

Methods and Results— Using a case-control study design, CRP in 131 patients with atrial arrhythmias was compared with CRP in 71 control patients. Among arrhythmia patients, 6 had frequent atrial ectopy or tachycardia, 86 had paroxysmal AF, 39 had persistent AF lasting >30 days, and 70 had lone arrhythmias. CRP was higher in arrhythmia than in control patients (median, 0.21 versus 0.096 mg/dL; P<0.001). Arrhythmia patients in AF within 24 hours before sampling had higher CRP than those in sinus rhythm (0.30 versus 0.15 mg/dL; P<0.001). CRP in controls was not different than in patients with atrial ectopy or tachycardia. Lone arrhythmia patients had a CRP of 0.21 mg/dL, which was not significantly lower than arrhythmia patients with structural heart disease (CRP, 0.23 mg/dL) but higher than controls (P=0.002). Persistent AF patients had a higher CRP (0.34 mg/dL) than paroxysmal AF patients (0.18 mg/dL; P=0.008); both groups had higher CRP levels than controls (P0.005).

Conclusions— CRP is elevated in AF patients. This study is the first to document elevated CRP in non-postoperative arrhythmia patients. These findings are reinforced by stepwise CRP elevation with higher AF burden. Although the cause of elevated CRP levels in AF patients remains unknown, elevated CRP may reflect an inflammatory state that promotes the persistence of AF.

Key Words: fibrillation • arrhythmia • inflammation • C-reactiveprotein

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				T. J. Wang, H. Parise, L. M. Sullivan, R. B. D'Agostino Sr, D. Levy, P. A. Wolf, R. S. Vasan, and E. J. Benjamin Obesity and the Risk of New-Onset Atrial Fibrillation--Reply JAMA, April 27, 2005; 293(16): 1975 - 1975. [Full Text] [PDF]

				K. Mandal, E. Torsney, J. Poloniecki, A. J. Camm, Q. Xu, and M. Jahangiri Association of High Intracellular, But Not Serum, Heat Shock Protein 70 With Postoperative Atrial Fibrillation Ann. Thorac. Surg., March 1, 2005; 79(3): 865 - 871. [Abstract] [Full Text] [PDF]

				L. M. Biasucci CDC/AHA Workshop on Markers of Inflammation and Cardiovascular Disease: Application to Clinical and Public Health Practice: Clinical Use of Inflammatory Markers in Patients With Cardiovascular Diseases: A Background Paper Circulation, December 21, 2004; 110(25): e560 - e567. [Abstract] [Full Text] [PDF]

				A. Shiroshita-Takeshita, G. Schram, J. Lavoie, and S. Nattel Effect of Simvastatin and Antioxidant Vitamins on Atrial Fibrillation Promotion by Atrial-Tachycardia Remodeling in Dogs Circulation, October 19, 2004; 110(16): 2313 - 2319. [Abstract] [Full Text] [PDF]

				Y. Ishii, M. J. Gleva, M. C. Gamache, R. B. Schuessler, J. P. Boineau, M. S. Bailey, and R. J. Damiano Jr Atrial Tachyarrhythmias After the Maze Procedure: Incidence and Prognosis Circulation, September 14, 2004; 110(11_suppl_1): II-164 - II-168. [Abstract] [Full Text] [PDF]

				C. S. Fox, R. S. Vasan, and E. J. Benjamin Parental Atrial Fibrillation as a Risk Factor for Atrial Fibrillation in Offspring--Reply JAMA, September 8, 2004; 292(10): 1175 - 1175. [Full Text] [PDF]

				A. S. Gami, G. Pressman, S. M. Caples, R. Kanagala, J. J. Gard, D. E. Davison, J. F. Malouf, N. M. Ammash, P. A. Friedman, and V. K. Somers Association of Atrial Fibrillation and Obstructive Sleep Apnea Circulation, July 27, 2004; 110(4): 364 - 367. [Abstract] [Full Text] [PDF]