High-Sensitivity C-Reactive Protein is a Predictor of Subsequent Atrial High-Rate Episodes in Patients with Pacemakers and Preserved Ejection Fraction.

Min-Tsun Liao,Chun-Kai Chen,Li-Ying Cheng,Ting-Tse Lin,Yen-Bin Liu,Hung-Wen Ting

doi:10.3390/jcm9113677

Abstract

Atrial fibrillation (AF) is associated with morbidity and mortality. Modern pacemakers can detect atrial high-rate episodes (AHREs) as a surrogate for AF. It remains controversial whether inflammation is a cause or a consequence of AF. This study investigated whether the inflammatory biomarker high-sensitivity C-reactive protein (hs-CRP) can predict subsequent AHREs. This study gathered prospective data from patients with pacemakers and a left ventricle EF ≥ 50% between 2015 and 2019. The hs-CRP and other cardiac biomarkers at baseline and device-detected AHREs, defined as atrial rate ≥ 180 bpm and duration ≥ 6 min, were determined. Cox regression analysis was used to estimate the independent predictors for AHREs. A total of 171 consecutive patients were included. During the median follow-up of 614 days, 66 patients (39%) developed subsequent AHREs. In the univariate Cox regression analysis, sick sinus syndrome (p = 0.005), prior AF (p < 0.001), mitral A velocity (p = 0.008), and hs-CRP (p = 0.013) showed significant association with the increased risk of AHREs. In the multivariate Cox regression model, hs-CRP (HR = 1.121, 95% confidence interval = 1.015–1.238, p = 0.024) retained its significance. Our results suggest that elevated hs-CRP could predict subsequent AHREs and that inflammation could play a role in AF pathogenesis in patients with preserved EF.

Highlights

Atrial fibrillation (AF) is the most common arrhythmia and is associated with various morbidities and mortality [1,2]
A trend of a higher level of high-sensitivity C-reactive protein (hs-CRP) was observed in patients with atrial high-rate episodes (AHREs) than in patients without AHREs
The main findings of this prospective study with a median follow-up of nearly 2 years are (1) nearly 40% of patients with pacemakers have device-detected AHREs ≥ 6 min during the follow-up period; (2) the prior AF, sinus syndrome (SSS), mitral A velocity, and hs-CRP value independently correlated with subsequent AHREs; (3) after adjusting the relevant predictors of subsequent AHREs, the hs-CRP level retained its significance in predicting the occurrence of subsequent AHREs; (4) the hs-CRP level was significantly associated with the AHRE burden; (5) the optimized cut-point value > 0.525 mg/L of hs-CRP had a significant discrimination and reclassification accuracy in predicting subsequent AHREs; and (6) only the baseline inflammatory biomarker hs-CRP, but not other cardiac biomarkers, was significantly associated with the subsequent AHREs

Summary

Introduction

Atrial fibrillation (AF) is the most common arrhythmia and is associated with various morbidities and mortality [1,2]. AF is responsible for a significant number of hospitalization and mortality events in heart failure (HF) with reduced ejection fraction (HFrEF) or preserved ejection fraction (HFpEF) patients [3]. AF may have a different pathogenesis in patients with reduced EF and preserved EF. Substantial evidence has linked inflammation to the initiation and perpetuation of AF. It remains elusive whether inflammation is a consequence or a cause of AF [6]. It is unclear whether inflammation has the same effect in normal atria and in atria with substantial structural remodeling [7]

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