High sensitivity C reactive protein levels and atrial fibrillation recurrence after catheter ablation for atrial fibrillation: A systematic review and meta‐analysis

Abstract

BackgroundAtrial fibrillation (AF) recurrence after AF ablation is not uncommon. High sensitivity C reactive protein (hs‐CRP) is a widely used inflammatory marker with a potential property to predict AF recurrence. We conducted a systematic review and a meta‐analysis to find an association between hs‐CRP levels and AF recurrence after ablation.MethodsWe searched PubMed, Embase, and Wiley‐Cochrane Library from inception to January 2022 for studies that reported hs‐CRP levels in patients who underwent AF ablation. Weighted mean difference (WMD) was used to evaluate the difference between hs‐CRP levels in post‐ablation AF recurrent and non‐recurrent group. Also, the difference between hs‐CRP levels in pre‐ and post‐ablation was determined.ResultsWe identified 10 studies, and a total of 789 patients were included (299 recurrent vs. 490 non‐recurrent patients). The mean age was 57.7 years (76.4% male). There was no difference in baseline hs‐CRP levels between AF recurrent and non‐recurrent group (WMD = 0.05, 95% CI = −0.04 to 0.15, p = 0.045). However, higher hs‐CRP levels post‐ablation were found in AF recurrent group (WMD = 0.09, 95% CI = 0.03–0.15, p < 0.001).ConclusionThere is no significant difference in baseline hs‐CRP levels between AF recurrent and non‐recurrent patients after AF ablation. However, higher post‐ablation hs‐CRP level was found in AF recurrent group. High Sensitivity C reactive protein may play a role as a predictor of AF recurrence.

Inflammatory Markers as Predictors of Atrial Fibrillation Recurrence: Exploring the C-Reactive Protein to Albumin Ratio in Cryoablation Patients

“…This observation might be indicative of higher baseline AF burden and higher inflammation in the AF recurrence group. However, a recently published meta-analysis reported that it was the post-ablation high-sensitivity CRP (hs-CRP) but not pre-ablation hs-CRP level that predicted AF recurrence [28]. The cause of inconsistency between our study and this meta-analysis regarding increased baseline CRP levels in patients with post-ablation recurrence is not clear, but the heterogeneity in patient characteristics might have contributed to the discrepancy.…”

Clarifying the association between high‐sensitivity C‐reactive protein and atrial fibrillation recurrence: A comprehensive response

“…In our study, hs-CRP emerges as a pivotal inflammatory factor intricately associated with inflammation and the development of AF. 2 Existing literature has proposed a cascade wherein inflammation triggers "atrial myocarditis," subsequently inducing electrical and structural changes in the atria, thereby initiating and perpetuating AF. 3 The measurement of acute-phase proteins, exemplified by hs-CRP, serves as a valuable window into a patient's prevailing inflammatory status.…”

Detailed causality between high‐sensitivity C‐reactive protein and recurrence of atrial fibrillation after catheter ablation

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The recurrence of atrial fibrillation (AF) remains an unresolved issue.Jaroonpipatkul and colleagues evaluated the association between high-sensitivity C-reactive protein (hs-CRP) and AF recurrence after catheter ablation. 1 The authors demonstrated that higher hs-CRP after ablation was associated with AF recurrence by performing a meta-analysis. Several concerns have been raised.Maintained sinus rhythm suppresses the inflammatory status.

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“…One of the reasons why pre‐procedural hs‐CRP level was not associated with the AF recurrence in their study may be a variety of duration and burden of AF at baseline. 1 It may be more appropriate to perform a pooled analysis to prepare a more homogeneous cohort, instead of performing a meta‐analysis.…”

“…In the authors' study, postprocedural hs‐CRP level, instead of pre‐procedural hs‐CRP level, was associated with AF recurrence. 1 The authors suggested that hs‐CRP may be an offender of AF recurrence, whereas hs‐CRP may only be a bystander of AF recurrence. What do the authors think about their causality?…”