Int J Cardiol Heart Vasc. 2026 Jan 23;63:101879. doi: 10.1016/j.ijcha.2026.101879. eCollection 2026 Apr.
ABSTRACT
BACKGROUND: Atrial fibrillation (AF) is associated with systemic inflammation, endothelial dysfunction, and adverse cardiovascular outcomes. While there is robust evidence, that inflammation contributes to AF pathogenesis, the existence of a reverse relation - whether AF contributes to inflammation - remains elusive. This study therefore evaluates the impact of rhythm control on systemic inflammation and endothelial function.
METHODS: In this prospective observational study, 124 patients with persistent AF undergoing successful rhythm control therapy (electrical cardioversion or catheter ablation) were followed for nine months. Various Cytokines, high-sensitivity C-reactive protein (hsCRP), flow-mediated dilation (FMD) and additional inflammatory biomarkers were measured at baseline, 1 week, 1 month, 3 months, and 9 months. FMD was assessed by high-resolution brachial artery ultrasound. Patients with AF recurrence throughout the follow-up period were excluded from primary analysis.
RESULTS: In patients without AF recurrence, FMD improved significantly from 6.3 % (4.6-8.3) to 7.6 % (5.1-8.8) (p < 0.001). HsCRP, IL-8 and fibrinogen declined modestly (p = 0.002, p < 0.001 and p < 0.001, respectively), whereas IL-2, IP-10, IL-12p70, MCP-1 and TNF-α increased significantly over time (all p < 0.001). Elevated pre-treatment hsCRP was weakly associated with AF recurrence (r = 0.20, p = 0.023; AUC = 0.61). IL-6 showed temporal variation but no sustained change from baseline.
CONCLUSION: Rhythm control therapy in persistent AF is associated with an improvement of endothelial function but not with a homogeneous improvement of systemic inflammatory serological profiles. Thus, the improvement in FMD appears to be mediated primarily by hemodynamic restoration rather than anti-inflammatory effects.
PMID:41631156 | PMC:PMC12860693 | DOI:10.1016/j.ijcha.2026.101879