<i>L</i>-Arginine, Asymmetric Dimethylarginine and Rhythm Outcome after Electrical Cardioversion for Atrial Fibrillation

Abstract

Objectives: It was our aim to study the levels of L-arginine, the substrate for nitric oxide and asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase, and their relation to the maintenance of sinus rhythm after electrical cardioversion for atrial fibrillation (AF), as well as the effects of angiotensin receptor blockade on these variables. Methods: In a double-blind, placebo-controlled study, patients with persistent AF were randomised to receive candesartan 8 mg once daily or placebo for 3–6 weeks before and candesartan 16 mg once daily or placebo for 6 months after cardioversion. As part of this study, plasma levels of L-arginine and ADMA were measured at baseline and at the end of the study. Results: Baseline levels of L-arginine, ADMA and the L-arginine/ADMA ratio were not predictive of rhythm outcome, and their levels were not influenced by treatment with candesartan. However, the L-arginine/ADMA ratio increased in patients who remained in sinus rhythm (n = 37) for 6 months when compared with patients with AF recurrence (n = 61; p = 0.008). Conclusion: Neither L-arginine nor ADMA or their ratio were predictive of rhythm outcome after cardioversion, and they were not influenced by treatment with candesartan. However, the L-arginine/ADMA ratio increased in patients still in sinus rhythm 6 months after cardioversion.

Plasma Dimethylarginine Levels and Carotid Intima–Media Thickness are related to Atrial Fibrillation in Patients with Embolic Stroke

“…On the other hand, markers of endothelial dysfunction normalize in AF patients after successful cardioversion or ablation [9,10]. In contrast, in a study by Tveit et al, L-arginine and asymmetric dimethylarginine (ADMA) were unaffected after cardioversion in AF patients and did not differ on follow-up between patients with persistent sinus rhythm and those with relapse of AF [11]. Thus, current findings are contradictory.…”

Biomarkers of Atrial Fibrillation Recurrence in Patients with Paroxysmal or Persistent Atrial Fibrillation Following External Direct Current Electrical Cardioversion

“…Cont. Changes in ADMA did not predict rhythm outcome after electrical cardioversion [223] Abbreviations: ADMA, asymmetric dimethylarginine; ANP, atrial natriuretic peptide; CVD, cardiovascular disease; BNP, brain natriuretic peptide; BMP10, bone morphogenetic protein 10; HF, heart failure; hs-CRP, high-sensitivity C-reactive protein; LVEF, left ventricular ejection fraction; NT-proBNP, N-terminal pro-B-type natriuretic peptide; sST2, soluble suppressor tumorigenisity-2; Gal-3, galectin-3; PIIINP, procollagen type III N terminal peptide; ICTP, type I collagen carboxyl telopeptide; FGF-23, fibroblast growth factor 23, cfc-mtDNA, cell-free circulating mitochondrial DNA.…”

“…There are controversial data for ADMA's predictive ability regarding AF recurrence after electrical cardioversion. Xia W et al (208) [223] reported that elevated ADMA levels were strongly associated with an increased risk of AF relapse within 1 month after electrical cardioversion. On the contrary, Tveit A et al (2010) [224] found that the levels of ADMA and the L-arginine/ADMA ratio did not exert predictive ability for sinus rhythm maintenance after electrical cardioversion, while the L-arginine/ADMA ratio remained elevated in patients with sinus rhythm for 6 months compared with patients with AF recurrence.…”

Asymmetric Dimethylarginine Levels are Highly Associated With Atrial Fibrillation in an Elderly Population

“…Results from another study indicate that high levels of ADMA are associated with an increased risk of AF recurrence within 1 month after electrical cardioversion [18]. The latter could not be confirmed in our recently published study in which neither L-arginine, nor ADMA were found to be predictive of rhythm outcome after cardioversion [19]. …”