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European Heart Journal 2004 25(19):1761; doi:10.1016/j.ehj.2004.08.002
Copyright © 2004 by the European Society of Cardiology.
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Letter to the Editor

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

Christopher J Boos*

Southampton General Hospital, Departmment of Cardiology, 18C Nightingale Rd, Portsmouth PO5 3JL, UK

* Southampton General Hospital, Southampton, England. Tel.: +44 7973 840 309; fax: +44 2392 866067 (E-mail: christopherboos{at}hotmail.com).

I read with great interest this potentially landmark study by Dernellis and Panaretou.1 The authors demonstrated that CRP concentration is a risk factor for recurrent and permanent atrial fibrillation (AF). 1 In addition, they also showed that treatment with oral methyl-prednisolone, given for up to four months following successful cardioversion for "persistent" AF, prevented AF recurrence or the development of permanent AF. The authors have thus suggested a novel way of improving sinus rhythm maintenance in cardioverted patients with AF of short duration (average duration 6.1 h), but without background inflammation.

In their study, 43–44% of included patients were diagnosed with hypertension at inclusion.1 The authors do not provide information on the number of included patients with cardiovascular disease but without the exclusion criteria of acute myocardial infarction or unstable angina.

In addition, no information is provided on the background medical therapy with respect to the treatment versus placebo groups. Recent studies have demonstrated the efficacy of both angiotensin converting enzyme inhibitors and angiotensin receptor blockers as adjuncts to successful rhythm control in atrial fibrillation.2–4 In addition, there is also emerging data to support improved sinus rhythm maintenance with statin treatment.5 This is of importance as these mentioned treatments have been known to have anti-inflammatory actions with consequent reduction in C-reactive protein levels.

References

  1. Dernellis J, Panaretou M. Relationship between C-reactive protein concentrations during glucocorticoid therapy and recurrent atrial fibrillation Eur Heart J 2004;25:1100-1107.[Abstract/Free Full Text]
  2. Madrid AH, Bueno MG, Rebollo JM, et al. Use of irbesartan to maintain sinus rhythm in patients with long-lasting persistent atrial fibrillation: a prospective and randomized study Circulation 2002;106:331-336.[Abstract/Free Full Text]
  3. Madrid AH, Escobar C, Rebollo JM, et al. Angiotensin receptor blocker as adjunctive therapy for rhythm control in atrial fibrillation: results of the irbesartan-amiodarone trial Card Electrophysiol Rev 2003;7:243-246.[CrossRef][Medline]
  4. Ueng KC, Tsai TP, Yu WC, et al. Use of enalapril to facilitate sinus rhythm maintenance after external cardioversion of long-standing persistent atrial fibrillation. Results of a prospective and controlled study Eur Heart J 2003;24:2090-2098.[Abstract/Free Full Text]
  5. Siu CW, Lau CP, Tse HF. Prevention of atrial fibrillation recurrence by statin therapy in patients with lone atrial fibrillation after successful cardioversion Am J Cardiol 2003;92:1343-1345.[CrossRef][ISI][Medline]

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