High-sensitivity C-reactive protein is predictive of successful cardioversion for atrial fibrillation and maintenance of sinus rhythm after conversion

Backgrounds Cardioversion for atrial fibrillation (AF) is the most effective treatment for the restoration of sinus rhythm (SR). Recently, an elevated level of hs-CRP has been shown to be associated with AF burden, suggesting that inflammation increases the propensity for persistence of AF. We examined whether the level of high-sensitivity C-reactive protein (hs-CRP) was predictive of the outcome of cardioversion for AF. Methods and results One hundred and six patients with a history of symptomatic AF lasting ≥ 1 day (age 63 ± 14 years, mean ± S.D.) underwent cardioversion. Echocardiography and hs-CRP assay were performed immediately prior to cardioversion. SR was restored in 84 patients (79%). By using selected cutoff values, multiple discriminant analysis revealed significant associations between successful cardioversion and a shorter duration of AF (AF duration ≤ 36 days, odds ratio (OR), 0.98; 95% confidence interval (CI), 0.97–0.99), smaller left atrial diameter (left atrial diameter ≤ 40 mm, OR 0.82, 95% CI 0.71–0.94), better-preserved left ventricular ejection fraction (left ventricular ejection fraction ≥ 60%, OR 0.92, 95% CI 0.86–0.99), and lower hs-CRP level (hs-CRP ≤ 0.12 mg/dL, OR 0.33, 95% CI 0.21–0.51). During a follow-up period of 140±144 days, AF recurred in 64 patients (76%). By using a cutoff value of hs-CRP ≥ 0.06 mg/dL, Cox proportional-hazards regression model found that only hs-CRP level was an independent predictor of AF recurrence (OR 5.30, 95% CI 2.46–11.5) after adjustment for coexisting cardiovascular risks. When patients were divided by the hs-CRP level of 0.06 mg/dL, percentage of maintenance of SR below and above the cutoff was 53% and 4%, respectively (log–rank test, p < 0.0001). Conclusions hs-CRP level determined prior to cardioversion represents an independent predictor of both successful cardioversion for AF and the maintenance of SR after conversion.