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European Heart Journal Advance Access originally published online on February 23, 2006
European Heart Journal 2006 27(7):886; doi:10.1093/eurheartj/ehi780
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Is atrial fibrillation an inflammatory disorder?

Demosthenes G. Katritsis

Department of Cardiology
Athens Euroclinic
9 Athanasiadou Street
Athens 115 21
Greece
Tel: +30 210 641 6600
Fax: +30 210 681 9779
E-mail address: dkatritsis{at}euroclinic.gr

I read with great interest the excellent review on the influence of inflammation in the pathogenesis of atrial fibrillation (AF) by Boos et al.1 As the authors have demonstrated, there is compelling evidence supporting the role of inflammation in the pathogenesis of this arrhythmia. I was surprised, however, to find no mention of the possible efficacy of beta-blockers with anti-inflammatory properties in this respect. Carvedilol, in particular, is a slightly beta 1-selective beta-blocker, which also possesses alpha 1-blocking and antioxidant properties.2 Indeed, part of its reported beneficial effects on ventricular remodelling effects and coronary microcirculation has been attributed to its antioxidant activities.2 Recently, we have provided evidence that carvedilol is probably more efficient than bisoprolol in the prevention of AF recurrences in an unselected patient population.3 In our study, 90 patients undergoing cardioversion of persistent AF were randomized to bisoprolol 5–10 mg once daily or carvedilol 12.5–25 mg twice daily. By intention-to-treat analysis, 23 (46%) patients in the bisoprolol group and 17 (32%) patients in the carvedilol group relapsed into AF, during the 1 year of total follow-up period (P=0.486). Patients treated with carvedilol had a 14% (hazard ratio=0.86) lower risk to relapse to AF when compared with patients on bisoprolol group. This issue deserves closer attention, particularly when discussing the limitations of current anti-arrhythmic drugs as far as their anti-inflammatory action is concerned.

References

  1. Boos CJ, Anderson RA, Lip GY. Is atrial fibrillation an inflammatory disorder? Eur Heart J 2006;27:136–149.[Abstract/Free Full Text]
  2. Yaoita H, Sakabe A, Maehara K, Maruyama Y. Different effects of carvedilol, metoprolol, and propranolol on left ventricular remodeling after coronary stenosis or after permanent coronary occlusion in rats. Circulation 2002;105:975–980.[Abstract/Free Full Text]
  3. Katritsis DG, Panagiotakos DB, Karvouni E, Giazitzoglou E, Korovesis S, Paxinos G, Anagnostopoulos CE, Camm AJ. Comparison of effectiveness of carvedilol versus bisoprolol for maintenance of sinus rhythm after cardioversion of persistent atrial fibrillation. Am J Cardiol 2003;92:1116–1119.[CrossRef][Web of Science][Medline]

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This Article
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
27/7/886    most recent
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