Association Between C‐Reactive Protein and Atrial Fibrillation Recurrence After Catheter Ablation: A Meta‐analysis

Abstract

Background: Atrial fibrillation (AF) is associated with inflammation. Increased serum C-reactive protein (CRP) levels are important representatives of an inflammatory state of AF. A variety of studies have evaluated whether increased CRP levels have an association with AF recurrence after catheter ablation. However, the results remain inconsistent, therefore, this meta-analysis was conducted to offer suggestions. Hypothesis: Increased baseline CRP have an association with AF recurrence after catheter ablation. Methods: Electronic databases including PubMed, Embase, Medline, ISI Web of Knowledge, and ScienceDirect were searched until December 31, 2012 for any CRP-associated studies. Overall and subgroup analyses were performed. Standardized mean difference (SMD) and 95% confidence interval (CI) were used to evaluate the associations between CRP levels and postablation AF recurrence. Statistical analysis was performed with Review Manager 5.2 and Stata 11.0. Results: Seven available studies were identified, which included 526 patients (179 recurrence vs 347 no recurrence). Overall, increased baseline CRP levels had significant positive association with postablation AF recurrence. The SMD in the CRP levels was 0.65 units (95% CI: 0.30-0.99), and the z-score for overall effect was 3.70 (P = 0.0002). The heterogeneity test showed that there were moderate differences between individual studies (P = 0.006, I 2 = 67%). Metaregression revealed that different sample sizes of studies possibly accounted for the heterogeneity. Positive associations were also found in subgroup analyses based on sample size. When stratifying for ethnicity, similarly significant associations were found in both European (Caucasian) and Asian populations. Conclusions: Investigations demonstrate that baseline CRP levels are greater in patients with postablation AF recurrence. Further studies with larger sample size and delicate design for CRP should be conducted. IntroductionAtrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice, and approximately onethird of all cardiac arrhythmia-related hospitalizations are due to AF.

Eosinophils in patients with lone atrial fibrillation

“…Although the association of inflammatory markers (CRP, IL‐2, TLR‐4 expression, monocyte‐to‐HDL ratio) and AF recurrence after catheter ablation has been evaluated in previous studies, our study found eosinophils to be independent predictors of AF recurrence after drug rhythm control strategies for the first time. It is also the first study which reports the association of inflammatory markers and AF recurrence in Chinese patients.…”

C‐reactive protein gene polymorphism predicts the risk of thromboembolic stroke in patients with atrial fibrillation: a more than 10‐year prospective follow‐up study

“…Many studies have also shown that the CRP level is not only significantly elevated in patients with AF, but is also closely related to AF burden [6,9]. Previous data have also demonstrated that increased CRP levels are associated with a greater risk of AF recurrence after successful cardioversion or catheter ablation [10][11][12]. Taken together, these findings suggest that inflammation may contribute to the development and perpetuation of AF.…”

Role of Monocytes in Heart Failure and Atrial Fibrillation

“…The role of inflammation in AF development is highlighted by the correlation with C‐reactive protein (CRP) and has been found, in postoperative patients, to be a surrogate marker for predictor of new‐onset AF . Also, postablation CRP levels can be used as a marker for risk of recurrence …”