Activation of generalised inflammatory reaction following electrical cardioversion

Abstract

Background: Restoration of sinus rhythm in patients with atrial fibrillation (AF) is associated with an increased risk of thrombo-embolic complications due to delayed return of the left atrial and left atrial appendage systolic function. Direct current cardioversion (DC), used for AF termination, may cause myocardial injury and subsequent activation of inflammatory response. A C-reactive protein (CRP) is a non-specific marker of inflammation.
Aim: To examine the effects of external DC of AF or atrial flutter (AFlut) on inflammatory processes.
Methods: The study group consisted of 35 patients (20 females and 15 males, mean age 67.9±9.7 years, range 46-83 years) with paroxysmal or persistent AF/AFlut who underwent elective DC. CRP plasma concentration was measured before and 24 hours after DC.
Results: The mean total DC energy was 431.2 J. CRP plasma concentration increased significantly following DC - from 3.9±3.4 ng/ml before DC to 7.2±6.7 ng/ml after DC (p<0.0001). CRP level correlated with body mass index (r=0.34, p<0.05), however, this correlation became non-significant after inclusion of the presence of diabetes into the statistical model. There was also a positive correlation between CRP values before and after DC (r=0.72, p<0.0001). No correlation between CRP and gender, total power of DC nor the number of DC shocks was detected.
Conclusions: External DC of AF/Aflut causes activation of inflammatory processes measured as a significant increase in the CRP plasma concentration.