Is atrial fibrillation an inflammatory disease reflected by elevated C-reactive protein?

Inflammation: a possible pathogenic link to atrial fibrillation

Atrial fibrillation (AF) is the most common sustained dysrhythmia in clinical practice. Despite the extensive studies, the pathophysiological mechanisms in AF, however, remain unclear. More recently, the data has been suggested that inflammatory process has been associated with development of AF. The evidence for the hypotheses included that: (1) Histological studies have demonstrated inflammatory infiltrates in AF patients and in animal models of AF; (2) inflammatory markers are increased in AF patients and is associated with successful cardioversion. And also, Inflammatory markers are not only associated with the presence of AF but also independently predicted increased risk for the development of future AF; (3) treatment with anti-inflammatory agents is associated with a decreased recurrence of AF. Although the studies suggest the existence of an association between inflammation and AF, many aspects remain elusive and require further investigation. Specifically, whether inflammation is an initiator or a perpetuator of AF; the effects of anti-inflammatory drugs on atrial remodeling and their exact role in the recurrence and perpetuation of AF. Inflammation may provide a potential target for pharmacological interruption of AF and may favorably affect atrial remodeling leading to important clinical benefits.

Inflammation in the genesis and perpetuation of atrial fibrillation

The prevalence and persistence of atrial fibrillation (AF) and the relative inefficacy of the currently available pharmacotherapy requires development of new treatment strategies. Recent findings have suggested a mechanistic link between inflammatory processes and the development of AF. Epidemiological studies have shown an association between C-reactive protein and both the presence of AF and the risk of developing future AF. In case-control studies, C-reactive protein is significantly elevated in AF patients and is associated with successful cardioversion. Moreover, C-reactive protein elevation is more pronounced in patients with persistent AF than in those with paroxysmal AF. Furthermore, treatment with glucocorticoids, statins, angiotensin converting enzyme inhibitors, and angiotensin II receptor blockers seems to reduce recurrence of AF. Part of this anti-arrhythmic effect may be through anti-inflammatory activity. This article reviews what is known about inflammation in genesis and perpetuation of AF, the putative underlying mechanisms, and possible therapeutic implications for the inhibition of inflammation as an evolving treatment modality for AF.