Abstract 2229: The Prognostic Power of Inflammatory Markers in Predicting Lone Atrial Fibrillation Recurrence
Inflammation has been proposed as one of the mechanisms involved in the pathogenesis of atrial fibrillation (AF). The role of inflammation in lone AF has not been extensively studied. Furthermore, the inflammatory markers have not been evaluated regarding their efficacy to predict lone AF recurrence.
Aim: To assess the circulating levels of different inflammatory markers after the first episode of persistent lone AF and evaluate them as predictors of AF recurrence.
Methods: In a prospective cohort analysis among 123 patients with symptomatic AF, 39 patients referred for cardioversion of the first episode of persistent lone AF were finally studied. Blood samples were taken before (baseline) and after cardioversion (at 1 hour, 24 hours, 1, 2, 4 and 6 weeks) for high sensitivity CRP (hs-CRP), TNFa, IL-6, IL-10, sICAM and sVCAM assessment. During a 12-month follow-up period, the recurrence of AF was monthly assessed by Holter ECG recordings. Patients were divided into Group A (n = 15: recurrence of persistent AF or AF duration > 1/3 of the total ECG recording time) and Group B (n = 24: no recurrence of persistent AF or AF duration < 1/3 of the total ECG recording time). An equal number of healthy volunteers (matched for age, sex, and Body Surface Area) served as the control group (Group C, n = 39).
Results: Baseline hs-CRP, IL-6, sICAM, and TNFa were higher, while IL-10 and sVCAM were lower in Group A than in Groups B and C. During the first 6 weeks of follow-up, IL-6 and sICAM levels remained unaltered in Group A, while they decreased significantly in Group B; no differences were observed between the two groups regarding hs-CRP, TNFa, IL-10 and sVCAM levels. A decrease < 36.1% in IL-6 one week after cardioversion and a decrease < 3.2% in sICAM two weeks after cardioversion, had the highest prognostic value for increased risk of AF recurrence (ROC analysis).
Conclusion: Among the evaluated inflammatory markers, IL-6 and sICAM changes are the most reliable and strong predictors of AF relapse after the first cardioverted episode of persistent lone AF. Their evaluation within two weeks offers the clinician an early prognostic tool to estimate the risk of AF relapse in the next year.