Kristoffer Henningsen

Prognostic impact of hs‐CRP and IL‐6 in patients with persistent atrial fibrillation treated with electrical cardioversion

Objective. The aim of this study was to assess the role of inflammatory processes in the development of atrial fibrillation (AF) and the prognostic impact of inflammatory markers in predicting long‐term risk of AF recurrence after electrical cardioversion (CV). Methods. High‐sensitivity C‐reactive protein (hs‐CRP) and interleukin‐6 (IL‐6) were measured in 56 patients with persistent AF (lasting mean 128 days (range 14–960), mean age 65 years (34–84)), 19 healthy volunteers and 19 patients with permanent AF. Patients with persistent AF underwent CV. Blood samples were taken prior to CV and after 1, 30 and 180 days. Results. The immediate success rate of CV was 88 %, while the total recurrence rate after 180 days was 68 %. Patients with permanent AF had significantly higher levels of hs‐CRP and IL‐6 than patients with persistent AF (p = 0.0011, p<0.001). Patients in sinus rhythm (SR) after 180 days had significantly lower baseline hs‐CRP (1.25 mg/L (0.5–2.4) versus 2.0 mg/L (0.9–3.3), p<0.001) and IL‐6 (1.96 pg/mL (1.35–2.7) versus 2.75 pg/mL (1.55–3.62), p<0.001) than patients with recurrent AF. Baseline IL‐6 was the only independent predictor of recurrent AF (p = 0.04) in a multivariate Cox analysis. Patients in the lowest hs‐CRP quartile (<0.8 mg/L) had significantly lower AF recurrence rates after 180 days (50 % versus 74 % in the other three quartiles combined; p = 0.0069). Conclusion. Patients with AF had elevated levels of inflammatory markers. Low hs‐CRP and IL‐6 prior to CV are associated with a lower risk of AF recurrence after CV.

Plasma YKL-40, a new biomarker for atrial fibrillation?

AIMS The aim of this study was to determine changes in a new potential biomarker plasma YKL-40 in patients with atrial fibrillation (AF) before and after electrical cardioversion (CV). METHODS AND RESULTS Plasma concentrations of YKL-40 were measured in 56 patients (mean age 65 years, range 34-84) with persistent AF (lasting mean 128 days, range 14-960), in 19 age-matched patients with permanent AF, and in 19 healthy subjects. The patients with persistent AF underwent CV. Plasma YKL-40 was measured prior to CV, and at follow-up after 24 h, 30 and 180 days. Patients with persistent AF had lower plasma YKL-40 than patients with permanent AF [70 microg/L (42-105)] vs. [138 microg/L (48-225)] (P = 0.003), and higher levels than healthy subjects [41 microg/L (29-52)] (P = 0.001). Patients (n = 22) who were still in sinus rhythm (SR) at follow-up 30 days after CV had unchanged plasma YKL-40 compared with baseline levels. The baseline levels of YKL-40 were correlated to the levels of IL-6, but not to high sensitivity C-reactive protein. CONCLUSION Patients with AF have significantly elevated levels of YKL-40. YKL-40 was not a significant predictor of successful CV to SR. Plasma levels of YKL-40 did not fall after restoration of SR.

Prognostic impact of hs-CRP and IL-6 in patients undergoing radiofrequency catheter ablation for atrial fibrillation

Aim. The aim of this study was to assess the predictive value of inflammatory markers in patients with paroxysmal/ persistent atrial fibrillation (AF) treated with radiofrequency (RF) catheter ablation. Methods. Forty-six consecutive patients, mean age 55 years (range 31 – 81 yrs), with paroxysmal or persistent AF were treated with either segmental or circumferential pulmonary vein isolation ablation technique. All patients presented with sinus rhythm on inclusion. Holter monitoring lasting at least 14 days was performed before ablation and after 3 months. Recurrent symptomatic AF or atrial tachycardia >10 minutes was considered failure and patients were offered a second ablation session. Interleukin-6 and high-sensitivity C-reactive protein were measured prior to ablation and at follow-up visits. Results. After a maximum of two ablations, 19 patients (41%) had SR without recurrence of AF after 12 months. Patients in SR had significantly lower left atrium diameter (p = 0.007) and lower values of both IL-6 (p = 0.007) and hs-CRP (p = 0.018) at baseline before ablation. IL-6 concentration prior to ablation was an independent predictor of recurrent AF (p = 0.027). Conclusion. In patients with a history of paroxysmal or persistent AF treated with RF catheter ablation, elevated levels of IL-6 and hs-CRP before ablation are independent predictors of recurrence of AF.

A polymorphism associated with increased levels of YKL-40 and the risk of early onset of lone atrial fibrillation

BackgroundPlasma levels of YKL-40 are elevated in patients with atrial fibrillation (AF). We hypothesized that a single nucleotide polymorphism (SNP) that affects YKL-40 plasma levels is associated to the risk of lone AF.FindingsWe included 178 young patients with lone AF and the first episode before the age of 40 years, and a control group of 875 healthy individuals. We analyzed a promoter SNP (−131CG) (rs4950928) in the Chitinase 3–like 1 (CHI3L1) gene encoding YKL-40, which had previously been associated with elevated levels of YKL-40.ConclusionsThe (−131CG) genotype was not associated with increased risk of AF. Genetically increased YKL-40 levels were not associated to AF.

Association of rs2200733 at 4q25 with early onset of lone atrial fibrillation in young patients.

Abstract Objective. Genome wide association studies have shown an association between rs2200733 at 4q25 and atrial fibrillation (AF). In this case-control study we investigate the association of rs2200733 and lone AF in young patients. Methods. We included 196 young patients with lone AF and the first episode before the age of 40 years. We analyzed the single nucleotide polymorphism (SNP) rs2200733 for the lone AF patients and compared them to a control group of 176 age matched healthy individuals. Results. No significant differences, in neither genotype distribution, nor minor allele frequencies were found between the lone AF patients and the healthy controls. Conclusion. Our results suggest that the rs220733 is not a risk factor for AF in patients with no other cardiovascular disease and with early onset of the arrhythmia.