Role of inflammation and oxidative stress in atrial fibrillation

Abstract

BACKGROUND Atrial fibrillation (AF) is the most common arrhythmia in clinical practice. There is increasing evidence that inflammation and oxidative stress contribute to the pathogenesis of AF, but their role remains poorly defined. Furthermore, it is unclear if inflammation and oxidative stress are associated with particular types of AF. OBJECTIVE The purpose of this study was to define the role of inflammation and oxidative stress in AF. METHODS Using a case-control study design, 305 patients with AF were compared to 150 control patients. AF was categorized into lone and typical AF, and further sub-categorized as paroxysmal, persistent or permanent AF. Serum concentrations of interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor (TNF)-α, monocyte chemotactic protein (MCP)-1, vascular endothelial growth factor (VEGF) and N-terminal pro-brain natriuretic peptide (NTpBNP) and urinary F2-isoprostanes, a measure of oxidative stress, were measured. RESULTS IL-6, IL-8, IL-10, TNF-α, MCP1, VEGF and NTpBNP concentrations were independently associated with AF (all P values <0.05), but F2-isoprostane excretion was not elevated (P=0.50). There was a graded increase in TNF-α (median [interquartile range (IQR)]: 6.8 [3.4–11.3], 8.0 [5.6–10.9], 10.1 [5.7–12.4] pg/ml, P<0.05) and NTpBNP (170.6 [67.3–481.9], 681.39 [310.3–1439.0], 1179.9 [653.1–2096.0] pg/ml, P<0.001) among the subgroups of paroxysmal, persistent and permanent AF, respectively. CONCLUSIONS This study shows that inflammatory biomarkers were significantly increased in patients with AF, supporting a strong association between inflammation and the arrhythmia. Surprisingly, urinary F2-isoprostanes, a sensitive index of systemic oxidative stress in vivo, were not increased in AF overall, or in different subtypes of AF.

EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication

“…267 A follow-up secondary analysis of the participants Cardiovascular Health Study participants further revealed that elevated CRP predicted incident AF. 268 Subsequent studies have demonstrated relationships between several different serologic markers of inflammation and AF, including IL-6, 269 TNF-a, 270 aldosterone 271 and simple white blood cell counts. 272 Analyses of multiple inflammatory biomarkers within the same study have suggested that IL-6 and osteoprotegerin 273 may be especially important.…”

Role of Tumor Necrosis Factor-α in the Pathogenesis of Atrial Fibrosis and Development of an Arrhythmogenic Substrate

“…12 In the presumor necrosis factor-α (TNF-α) is a proinflammatory cytokine that has been implicated in the pathogenesis of a number of cardiovascular diseases, including acute myocardial infarction, heart failure, atherosclerosis and sepsisrelated cardiac dysfunction. 1, 2 In healthy individuals, the plasma and cardiac levels of TNF-α are both low, suggesting that TNF-α has little physiological importance in the normal heart.…”

The effect of nebivolol on P wave duration and dispersion in patients with Behçet’s disease; a prospective single-arm controlled study

“…Several studies have demonstrated that PD, which is considered to be a risk factor for AF, is higher in patients with BD than control subjects (9, 10), AF and prolonged PD is related with ongoing inflammation and endothelial damage/dysfunction (32)(33)(34)(35). Like most of the vasculitic pathologies, inflammation, the endothelial damage and dysfunction are apparently associated with the etiopathogenesis of BD.…”