Abstract
In recent years a growing body of evidence supported the role of inflammation in the initiation, maintenance and outcome of atrial fibrillation (AF). Nevertheless, despite a large amount of information, whether AF or the underlying structural heart disease (SHD) is the cause of the inflammatory process is still under debate. We, therefore, sought to determine if the inflammatory process reflect an underlying disease or the arrhythmia ‘per se’. We evaluated plasma levels of soluble Interleukin 2 Receptor Alpha (sIL-2Rα), TNF-α and IL-18 in 100 consecutive patients with permanent AF, (43 with a SHD and 57 without a SHD) compared to 121 age and sex-matched controls which had normal sinus rhythm. We also evaluated the endothelial function in both groups of patients using reactive hyperemia index (RHI) values measured by Endo-PAT2000. Compared to controls, AF patients showed higher circulating levels of inflammatory markers and a lower mean value of RHI. At multiple logistic regression analysis, the inflammatory markers and RHI were significantly associated with AF presence, whereas ROC curve analysis had good sensitivity and specificity in inflammatory variables and RHI for AF presence. No significant association was observed in the group of permanent AF patients, between inflammatory markers and the presence of an underlying SHD. These findings could help to clarify the role of inflammation in subjects with AF and suggest that the markers of systemic inflammation are not associated with the underlying cardiovascular disease, rather with the atrial fibrillation ‘per se’.
Highlights
Atrial fibrillation (AF) is the most common cardiac rhythm disorder and it represents one of the major causes of heart failure, stroke, sudden death and cardiovascular morbidity worldwide [1]
We found that the "inflammatory cytokines milieu"
Tumor necrosis factor α (TNF-α)) of permanent AF subjects is significantly associated with arrhythmia but not with an underlying cardiovascular disease
Summary
Atrial fibrillation (AF) is the most common cardiac rhythm disorder and it represents one of the major causes of heart failure, stroke, sudden death and cardiovascular morbidity worldwide [1]. A few studies [7, 8] investigated this field assessing the circulating levels of CRP mostly in subjects with LAF and with SHD, without clarifying if this marker is associated with the AF ‘per se’ or rather with the underlying cardiovascular disease. These studies have investigated the inflammatory pathway of atrial fibrillation patients only by determine CRP plasma levels, and in recent years numerous evidence [9] suggest to avoid the use of the historical term "lone AF"
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