PARIS, FRANCE. There is ample evidence that catheter ablation (PVI) for atrial fibrillation (AF) is accompanied by a state of systemic inflammation. What is not known is whether the extent of the post-procedure inflammation, as measured by C-reactive protein (CRP) level, is helpful in predicting the short- and long-term success of the procedure.
A team of French EPs investigated this question in a recent study of 125 afibbers who had their first AF ablation between July 2005 and April 2007. Most of the patients (78%) were male, 21% had underlying heart disease, 14% had hypertension, and 52% had the paroxysmal variety of AF. All underwent a standard segmental pulmonary vein isolation procedure (Haissaguerre protocol) and had their blood level of CRP measured prior to the procedure and at 1, 2 and 3 days following the procedure. The CRP level peaked on day 2 with an average level of 40 mg/L (4 mg/dL).
The researchers observed a clear correlation between the day 2 CRP level and the incidence of early arrhythmia occurrence. The average CRP level on day 2 for patients who experienced an arrhythmia (AF, tachycardia or incessant PACs) during the first month following the procedure was significantly lower (32 mg/L) than for those who did not experience early recurrence (49 mg/L). However, there was no significant difference in CRP levels between patients who did or did not experience arrhythmia recurrence in the 13-month follow-up period beyond the first month. The researchers speculate that location or depth of the radiofrequency (RF) lesions could influence the systemic inflammation response.
Lellouche, N, et al. Usefulness of C-reactive protein in predicting early and late recurrences after atrial fibrillation ablation. Europace, Vol. 11, May 2009, pp. 662-64