Post-cardioversion time Course of Atrial Remodeling Markers and their Association with Recurrence in Subjects with Long-standing, Persistent Atrial Fibrillation

Background. Activation of the renin-angiotensin-aldosterone axis with elevation of in-flammatory markers and the resulting fibrosis play a very important role in atrial remod-eling in patients with atrial fibrillation (AF), which is associated with post-cardioversion recurrence.Aim of the study. The purpose of the study was to describe the time course of angiotensin II (AngII), aldosterone, and of the amino terminal pro-peptide of type III pro-collagen (PIIINP) following cardioversion, and their association with arrhythmia recurrence. Methods. Ninety-nine subjects with long-standing, persistent, non-valvular atrial fibril-lation who underwent successful electrical cardioversion were included, with a 6 month follow up. Angiotensin II (AngII), aldosterone and PIIINP concentrations were mea-sured at 0, 1, 7, 30, and 180 d. Two groups were formed for the analysis: continuing sinus rhythm and recurrence of AF.Results. 53% of the subjects experienced recurrence of AF. Subjects with recurrence had larger left atrial diameters and lower global peak atrial longitudinal strain (8.7 vs. 19.7%; p < 0.001), higher levels of AngII (431.85 vs. 257.97 pg/mL; p = 0.003) at 180 d, higher pre-cardioversion levels of aldosterone, (11.42 vs. 5.46 pg/mL; p = 0.048) at 1 d (12.01 vs. 5.05 pg/mL; p = 0.004) and at 180 d (12.66 vs. 7.51 pg/mL; p = 0.011). There were no differences in PIIINP levels between both groups. Conclusions. Electrical post-cardioversion recurrence in subjects with long-standing, persistent AF is associated with elevated levels of AngII and aldosterone. (c) 2022 Instituto Mexicano del Seguro Social (IMSS). Published by Elsevier Inc. All rights reserved.

Automated summary

Atrial remodeling in patients with atrial fibrillation (AF) is associated with activation of the renin-angiotensin-aldosterone axis, elevation of inflammatory markers, and fibrosis. Following cardioversion, elevated levels of angiotensin II and aldosterone are associated with AF recurrence.