Abstract
We aimed to investigate whether or not cardiotrophin-1 (CT-1) can be used as a predictor of sinus rhythm constancy in patients with atrial fibrillation (AF) converted to sinus rhythm. Thirty two patients with AF (48-78 years), without any structural heart disease were enrolled for the study. The control group consisted of 32, age and gender matched healthy persons. Measurements of CT-1 were made after transthoracic and transesophageal echocardiography prior to cardioversion (CV). Relapses of AF were investigated by monthly electrocardiograms (ECGs) and ambulatory ECGs at 1st, 3rd, and 6th month. At the end of 6th month, measurements of CT-1 were repeated. At the beginning patients with AF had increased CT-1 levels when compared to controls (0.94 ± 0.32 pg/mL vs. 0.30 ± 0.12 pg/mL, [p < 0.001]). At the end of follow-up of the 32 patients, 17 (53%) had AF relapse. Age, initial duration of AF, left ventricle diameters, ejection fraction, left atrium appendix flow rates were similar among patients with and without AF relapse. However, basal left atrium diameter (4.24 ± 0.14 cm vs. 4.04 ± 0.22 cm, p = 0.005), pulmonary artery pressure (32.82 ± 5 vs. 28.60 ± 6.23 mmHg, p = 0.004) and CT-1 values (1.08 ± 0.37 vs. 0.82 ± 0.16 pg/mL, p = 0.02) were significantly increased in patients with AF relapse. Furthermore, patients with relapsed AF had higher CT-1 levels at 6th month when compared to those in sinus rhythm (1.00 ± 0.40 vs. 0.71 ± 0.23 pg/mL). We conclude that post-CV, AF relapses are more frequent among patients with increased baseline CT-1 levels, and CT-1 may be a potential predictor of AF relapse.
Highlights
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia [1]
We aimed to investigate the role of CT-1 in AF remodeling and whether CT-1 can be used as a predictor of sinus rhythm maintenance among persistent AF patients converted to sinus rhythm via electrical CV
In our study CT-1 levels over 0.47 pg/mL reflected the pathologic limit for healthy controls and CT-1 > 0.89 pg/mL was associated with approximately 9-fold increased AF relapse risk in patients converted to sinus rhythm
Summary
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia [1]. The prevalence of AF doubles with each advancing decade of age, from 0.5% at age 50-59 years to almost 9% at age 80-89 years [2]. History of diabetes mellitus, hypertension, cardiac failure, prior stroke or transient ischemic attack, female gender, and vascular diseases are risk factors for stroke in AF while some of these factors are involved in the development and persistence of AF [3,4,5]. Recurrent fibrillatory activity promotes progressive electrical and tissue structural remodeling, [6,7,8] and reduction of left atrial (LA) endocardial voltage through fibrosis [9]. These remodeling mechanisms affect LA volumes, endocardial voltages and conduction velocities [10]
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