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European Heart Journal 2004 25(13):1100-1107; doi:10.1016/j.ehj.2004.04.025
Copyright © 2004 by the European Society of Cardiology.
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Clinical research

Relationship between C-reactive protein concentrations during glucocorticoid therapy and recurrent atrial fibrillation

John Dernellis* and Maria Panaretou

Department of Cardiology, Vostanion Hospital, 1 Kathigitou Karakatsani Street, 81100 Mytilini, Greece

* Corresponding author. Tel.: +30-2251026588; fax: +30-2251028787
E-mail address: dernellis{at}yahoo.gr

Received 29 January 2004; revised 10 April 2004; accepted 22 April 2004 See page 1089 for the editorial comment on this article1

Abstract

Background Little direct information is available on the effect of C-Reactive Protein (CRP) lowering on the reduction of recurrent atrial fibrillation (AF).

Methods and Results We compared low-dose glucocorticoid therapy (16 mg methylprednisolone for 4 weeks tapered to 4 mg for 4 months) and placebo in 104 patients who had experienced persistent AF with a median concentration of CRP 1.14 mg/dL (min=0.01, max=2.58). Methylprednisolone reduced recurrent AF (primary end-point) from 50% in the placebo group to 9.6% in the glucocorticoid group and permanent AF (expanded end-point) from 29% in the placebo group to 2% in the glucocorticoid group. Survival distributions for methylprednisolone were significantly different (for both primary and expanded end-point, ). In multivariate Cox analysis, average CRP concentrations during follow-up were significant predictors of the primary end-point, with a relative risk 6.72 () and the expanded end-point, with a relative risk of 11.67 ().

Conclusions CRP concentration is a risk factor for recurrent and permanent AF. Methylprednisolone successfully prevents recurrent and permanent AF.

Key Words: Inflammation • C-reactive protein • Atrial fibrillation • Glucocorticoid


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