Elevated CRP = cardioversion failure

IOANNINA, GREECE. Several studies have uncovered an association between elevated levels of the inflammation marker C-reactive protein (CRP) and atrial fibrillation (AF). Inflammatory markers, mainly CRP, have been related to the risk of developing AF, the persistence of AF (paroxysmal, persistent, permanent), recurrence after cardioversion, and left atrium enlargement. Now Greek researchers weigh in with a study designed to determine the relationship between CRP level prior to cardioversion and time to first recurrent afib episode.

The study included 60 patients with persistent afib between the ages of 61 and 75 years, 60% of whom were men. The participants were free of valvular heart disease, congestive heart failure, prior heart attack, and thyroid dysfunction, so were a relatively healthy group although not classified as lone afibbers. A significant exclusion criteria was that the patients could not have been taking antioxidants or multivitamins. They had their CRP level measured prior to direct current cardioversion and were given amiodarone after the conversion (200 mg/day x 3 during first week, 200 mg/day x 2 during second week, and 200 mg/day thereafter). Patients who did not convert or who reverted back to AF within an hour were excluded from further follow-up.

The researchers found a clear correlation between CRP level and the percentage of patients who remained in sinus rhythm over the 3-year follow-up period. In the group of patients with a CRP level less than 0.43 mg/dL (4.3 mg/L), 45% were still in sinus rhythm at the end of 3 years. The corresponding figures for CRP levels between 0.43 and 0.8 mg/dL and CRP level greater than 0.8 mg/dL were 13% and 17% respectively. The researchers conclude that baseline CRP levels can be used to estimate the likelihood of persistent afibbers remaining in sinus rhythm after undergoing a successful electrical cardioversion.

Korantzopoulos, P, et al. Long-term prognostic value of baseline C-reactive protein in predicting recurrence of atrial fibrillation after electrical cardioversion. PACE, Vol. 31, October 2008, pp. 1272-76

Editorís comment: This study adds to the evidence of a close association between inflammation, as measured by CRP level, and the risk and persistence of AF. Although it is not entirely clear whether inflammation causes AF or AF causes inflammation, it would seem prudent for afibbers to maintain their CRP levels as low as possible. This can be achieved by regular supplementation with such natural anti-inflammatories as Zyflamend, beta-sitosterol, bromelain, curcumin, boswellia, Moducare, quercetin, and fish oil.