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Presence of AF at time of blood draw associated with inflammation

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Atrial fibrillation present at the time of blood draw, rather than a history of AF, was independently associated with increased C-reactive protein and interleukin-6 levels, results from a case-control study suggested.

Researchers enrolled 167 consecutive patients with paroxysmal or persistent AF and 207 control patients. They then extracted blood from intracardiac and extracardiac sites from a subset of 46 patients undergoing curative AF ablation.

They reported no differences in peripheral venous CRP and IL-6 levels in patients with and without a history of AF. Those patients with persistent AF, however, had elevated CRP and IL-6 levels when compared with those with paroxysmal AF. Patients in AF at the time of blood draw also had significantly higher CRP and IL-6 than those in sinus rhythm. Following adjustment for potential confounding variables, the presence of AF at the time of blood draw was associated with higher CRP (OR=1.79; 95% CI, 1.20-2.66) and elevated IL-6 levels (OR=1.69; 95% CI, 1.11-2.58). Patients in AF at the time of blood draw also had larger left atrial volume than those in sinus rhythm (130 ± 38 mL vs. 111 ± 34 mL; P=.005).

“CRP and IL-6 levels are significantly elevated during AF but not necessarily in patients with a history of AF,” the researchers wrote. “During AF, there appears to be intracardiac sequestration of inflammatory cytokines, potentially pointing to an important mechanism by which atrial remodeling occurs.”

Study limitations included caution from the researchers against inferring a causative relationship between the presence of AF at blood draw and elevated inflammatory markers.

“Because the significant differences in inflammatory markers persisted even when the study was restricted to groups that were more similar (such as within AF groups) and after multivariate adjustment, it does not appear that baseline differences between individuals with and those without a history of AF were responsible for our positive findings,” they wrote.

Marcus GM. Heart Rhythm. 2010;7:149-154.

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