Systemic inflammation as a trigger of Atrial Fibrillation

Abstract

Inflammation, high sympathetic tone, electrolyte changes and chronic kidney disease (CKD) are among the risk factors of postoperative atrial fibrillation (AF).(1) Studies show that elevated C-reactive protein levels may predict recurrent atrial arrhythmias (2) We present a case of a 70-year-old woman with paroxysmal atrial fibrillation who developed systemic inflammatory response syndrome and underwent unsuccessful electrical cardioversion of AF after pacemaker implantation.A 70-year-old woman diagnosed with symptomatic tachycardia-bradycardia syndrome, paroxysmal AF, chronic heart failure (NYHA II), hypertension, chronic kidney disease, after laparoscopic adrenalectomy due to Cushing syndrome, after mastectomy due to breast cancer was referred to the Department of Arrhythmias, Institute of Cardiology, Warsaw for pacemaker implantation. Physical examination revealed good general condition, lower limb edema and vaginal erythematous skin lesions corresponding to the clinical manifestation of candidiasis. Sinus rhythm with a heart rate of 62 beats per minute (bpm) was observed on ECG. At entry, laboratory investigations showed: white blood count (WBC)1071 cells/mm3; C-reactive protein 0.55 mg/dl; creatinine 1.4 ml/ min/1.73 m2; urea 79.4 mg/dl. Urine tests were performed at admission, showing no abnormalities. The patient underwent dual chamber pacemaker (DDD) implantation preceded by 1.5 g cefuroxime infusion. In the early post-implantation period AF with a high ventricular rate (150 bpm) was observed. Electrical cardioversion was performed to restore sinus rhythm. In 3 hours after successful intervention, sinus