Rhythm control in persistent atrial fibrillation improves endothelial function without uniform anti-inflammatory effects: A 9-month prospective cohort study

Abstract

Background

Atrial fibrillation (AF) is associated with systemic inflammation, endothelial dysfunction, and adverse cardiovascular outcomes. While there is robust evidence, that inflammation contributes to AF pathogenesis, the existence of a reverse relation – whether AF contributes to inflammation − remains elusive. This study therefore evaluates the impact of rhythm control on systemic inflammation and endothelial function.

Methods

In this prospective observational study, 124 patients with persistent AF undergoing successful rhythm control therapy (electrical cardioversion or catheter ablation) were followed for nine months. Various Cytokines, high-sensitivity C-reactive protein (hsCRP), flow-mediated dilation (FMD) and additional inflammatory biomarkers were measured at baseline, 1 week, 1 month, 3 months, and 9 months. FMD was assessed by high-resolution brachial artery ultrasound. Patients with AF recurrence throughout the follow-up period were excluded from primary analysis.

Results

In patients without AF recurrence, FMD improved significantly from 6.3 % (4.6–8.3) to 7.6 % (5.1–8.8) (p < 0.001). HsCRP, IL-8 and fibrinogen declined modestly (p = 0.002, p < 0.001 and p < 0.001, respectively), whereas IL-2, IP-10, IL-12p70, MCP-1 and TNF-α increased significantly over time (all p < 0.001). Elevated pre-treatment hsCRP was weakly associated with AF recurrence (r = 0.20, p = 0.023; AUC = 0.61). IL-6 showed temporal variation but no sustained change from baseline.

Conclusion

Rhythm control therapy in persistent AF is associated with an improvement of endothelial function but not with a homogeneous improvement of systemic inflammatory serological profiles. Thus, the improvement in FMD appears to be mediated primarily by hemodynamic restoration rather than anti-inflammatory effects.