Long‐Term Prognostic Value of Baseline C‐Reactive Protein in Predicting Recurrence of Atrial Fibrillation after Electrical Cardioversion

Abstract

An increasing body of evidence links atrial fibrillation (AF) to the inflammatory state. It has been suggested that increased C-reactive protein (CRP) levels are associated with greater risk of AF recurrence at short- and mid-term. We sought to investigate the association between CRP and long-term risk of AF recurrence. This was a prospective observational study. We investigated the association between baseline CRP levels and recurrence of AF over a 3-year follow-up period after successful electrical cardioversion (EC). A total of 60 patients were studied (mean age: 68.4 +/- 7.2 years, 60% men). All patients were receiving amiodarone for sinus rhythm maintenance. We further divided the study population into three tertiles according to the values of baseline CRP (tertile 1: <0.43 mg/dL; tertile 2: 0.43-0.8 mg/dL; tertile 3: >0.8 mg/dL). Overall, 75% of patients relapsed into AF during the 3-year study period. AF recurrence was significantly lower in the 1st CRP tertile group (P = 0.039). The Kaplan-Meier survival analysis showed that the rate of AF recurrence was significantly lower in the lowest CRP tertile (log rank; P < 0.001). In a multivariable Cox regression model adjusted for other potential covariates, only CRP (upper two tertiles) was an independent predictor of AF recurrence (heart rate: 6.3, 95% confidence interval: 3.1-12.7, P < 0.001). Our findings suggest that baseline CRP levels before EC have an independent prognostic value in predicting the long-term risk of AF recurrence.