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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/ehi781
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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?: reply

Christopher J. Boos

Haemostasis, Thrombosis, and
Vascular Biology Unit
University Department of Medicine
City Hospital
Birmingham B18 7QH
UK

Gregory Y.H. Lip

Haemostasis, Thrombosis, and
Vascular Biology Unit
University Department of Medicine
City Hospital
Birmingham B18 7QH
UK
Tel: +44 121 507 5080
Fax: +44 121 554 4083
E-mail address: g.y.h.lip{at}bham.ac.uk

We thank Katritsis for his supportive comments in response to our article dealing with the concept of inflammation and atrial fibrillation (AF).1,2 He has emphasized the anti-inflammatory effects of beta-blockers, in particular carvedilol, as an additional mechanism to explain the drugs' anti-arrhythmic effects in preventing AF.

We agree that there are some data available, which conceptually supports potential immunoregulatory properties for several beta-blockers, for example, bisoprolol and metoprolol in patients with dilated cardiomyopathy and carvedilol in patients with dilated cardiomyopathy.3–5 However, at present, there is a lack of convincing data to show superiority of carvedilol over other beta-blockers in the prevention or treatment of AF.

In the study by Katritsis et al.6 comparing carvedilol with bisoprolol for the prevention of AF after cardioversion, there was no significant difference in AF relapse rates, over the 1-year follow up, between the two groups (P=0.47). In a further study, Merritt et al.7 did demonstrate lower rates of AF after cardiac surgery among patients treated with carvedilol (n=26) compared with those treated with metoprolol/atenolol (n=89); however, this was an observational retrospective study. Neither of these two studies investigated the potential relationship between drug efficacy, AF, and/or its inflammatory substrate.

Although we do accept the need for further investigation into the potential anti-inflammatory/antioxidant effects of beta-blockers in terms of AF prevention, the superiority of carvedilol over other beta-blockers in terms of AF prevention has not been clearly demonstrated to date. Furthermore, we feel that, at present, it is simply not possible to clearly dissociate the potential anti-inflammatory effects of carvedilol and other beta-blockers from their favourable haemodynamic and anti-adrenal effects in the setting of AF.

References

  1. Katritsis DG. Is atrial fibrillation an inflammatory disorder? Eur Heart J 2006, doi:10.1093/eurheartj/ehi781.
  2. Boos CJ, Anderson RA, Lip GYH. Is atrial fibrillation an inflammatory disorder? Eur Heart J 2006;27:136–149.[Abstract/Free Full Text]
  3. Ohtsuka T, Hamada M, Hiasa G, Sasaki O, Suzuki M, Hara Y, Shigematsu Y, Hiwada K. Effect of beta-blockers on circulating levels of inflammatory and anti-inflammatory cytokines in patients with dilated cardiomyopathy. J Am Coll Cardiol 2001;37:412–417.[Abstract/Free Full Text]
  4. Yasunari K, Maeda K, Nakamura M, Watanabe T, Yoshikawa J, Asada A. Effects of carvedilol on oxidative stress in polymorphonuclear and mononuclear cells in patients with essential hypertension. Am J Med 2004;116:460–465.[Medline]
  5. Calo LA, Semplicini A, Davis PA. Antioxidant and anti-inflammatory effect of carvedilol in mononuclear cells of hypertensive patients. Am J Med 2005;118:201–202.[Medline]
  6. 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]
  7. Merritt JC, Niebaur M, Tarakji K, Hammer D, Mills RM. Comparison of effectiveness of carvedilol versus metoprolol or atenolol for atrial fibrillation appearing after coronary artery bypass grafting or cardiac valve operation. Am J Cardiol 2003;92:735–736.[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-a    most recent
ehi781v1
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