Inflammation in Atrial Fibrillation

Perspective:

The following are 10 points to remember from this review of the role of inflammation in atrial fibrillation (AF):

1. C-reactive protein (CRP), a marker of inflammation, is a risk factor for recurrences of lone AF and for recurrent AF post-cardioversion.

2. In large cohort studies such as the Women’s Health Study, elevated CRP levels have been independently predictive of the development of AF.

3. Tumor necrosis factor-α, a pleiotropic proinflammatory molecule, is a predictor of ischemic stroke in patients with persistent AF.

4. Levels of another marker of inflammation, interleukin-6, have been found to correlate with the duration of AF and with left atrial size.

5. Interleukin-8 promotes neutrophil-mediated organ injury and several studies have demonstrated elevated levels of interleukin-8 in patients with persistent/permanent AF.

6. The available evidence suggests that inflammation is both a cause and a consequence of AF.

7. Most studies have shown that CRP levels are higher in patients with AF and structural heart disease than in patients with lone AF.

8. Inflammation is linked to the prothrombotic state associated with AF through a variety of potential mechanisms, including endothelial activation/damage, platelet activation, and increased fibrinogen expression.

9. Studies that have investigated whether anti-inflammatory agents such as statins can prevent AF have reported mixed results.

10. At present, there are not enough data to support the clinical use of markers of inflammation in the management of patients with AF.

Clinical Topics: Arrhythmias and Clinical EP, Dyslipidemia, EP Basic Science, Atrial Fibrillation/Supraventricular Arrhythmias, Nonstatins, Novel Agents, Statins

Keywords: Inflammation, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Electric Countershock, Women's Health, Risk Factors, Tumor Necrosis Factor-alpha, Heart Diseases, Biological Markers, Atrial Fibrillation, Fibrinogen, Platelet Activation


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