| BackgroudAtrial fibrillation (AF) is the most commonly occurring arrhythmias. Impaired ventricular function,disorder of ventricular rate/ rhythm and mural thrombosis of atrium, are the chief pathophysiological characteristics of AF. Presently, the precise pathogenesy of AF is not clear. For the past few years, there were some reports about the relationship among inflammation, oxidative stress, renin-angiotensin system (RAS) and AF. The basic researchs on AF, and founding mechanism-based therapeutic approaches would find some way to treat AF.The therapeutic approaches of AF include cardioversion, controlling ventricular rate and precaution of complications. Some methods of cardioversion, such as antiarrhythmic and operation, are less effective. The fee of radio frequency catheter ablation is expensive in China. R-wave synchronized direct-current cardioversion is an effective method of cardioversion. Antiarrhythmic drug can strengthen that effectivity. However, part of patients cannot obtain sinus rhythm through electrical conversion. Presently, the effects that predict the electrical cardioversion restore sinus rhythm in patients with atrial fibrillation are paid close attention to.Aims1. To study the relationship among the level of hsCRP, Homocysteine, Angiotensin II, left atrial dimension and AF in the blood-serum and clinic classifications of atrial fibrillation.2. To study the effects that predict the electrical cardioversion restore sinus rhythm in patients with atrial fibrillation...MethodsPARTâ… : 64 patients with atrial fibrillation and 30 outpatients in sinus rhythm who were underwent routine physical examination were enrolled in test group and control group respectively. Test group was divided into three subgroups, (paroxysmal AF, persistent AF, permanent AF). The differences of left atrial dimension (LAD), left ventricular end-diastolic dimension (LVEDD), left ventricular ejection fraction (LVEF), the level of CRP, Hcy and Angiotensin II between test group and control group, as well as paroxysmal AF, persistent AF, permanent AF, were analyzed respectively.PARTâ…¡: 43 patients with atrial fibrillation who underwent electrical cardioversion and 30 outpatients in sinus rhythm who were underwent routine physical examination were enrolled in test group and control group respectively. Test group was divided into two subgroups. One is the successful cardioversion group; the other is the failed cardioversion group according to the results of electrical cardioversion (CV). The differences of left atrial dimension (LAD), left ventricular end-diastolic dimension (LVEDD), left ventricular ejection fraction (LVEF), pre-CV CRP levels between test group and control group were analyzed.The differences of sex,age, coronary heart disease (CHD), hypertension, valvular heart disease (VHD), left atrial dimension (LAD), left ventricular end-diastolic dimension (LVEDD), left ventricular ejection fraction (LVEF), pre-CV CRP levels and the duration of AF between the successful cardioversion group and the failed cardioversion group, were analyzed respectively. Patients in successful electrical cardioversion group were followed up throght telephone or interview in clinic service . The differences of left atrial dimension, pre-CV CRP levels were analyzed. Results 1. Compared with the control group, LAD was lager (P<0.05) in the test group; compared with the cases of paroxysmal AF, LAD was lager (P<0.05) in the cases of persistent AF, compared with the cases of persistent AF, LAD was lager (P<0.05) in the cases of permanent AF. Compared with the control group, LVEF was lager (P<0.05) in the test group. There was no difference of LVEDD between the control group and the test group. 2. Compared with the control group, the level of hsCRP, Hcy in the blood-serum was higher in the test group (P<0.05); compared with the cases of paroxysmal AF, the level of hsCRP, Hcy in the blood-serum was higher in the cases of persistent AF and permanent AF, but there was no difference between persistent AF and permanent AF; compared with the control group, the level of Angiotensin II was higher in the cases of persistent AF and permanent AF, but there was no difference between persistent AF and permanent AF as well as control group and paroxysmal AF.3. Compared with successful electroversion group, age was older (P<0.05), LAD was more lager (P<0.05), patients with VHD were more(P<0.05), the duration of AF were longer(P<0.05), and CRP level was higher (P<0.05) in the failed electroversion group. In a multivariable analysis, CRP lever OR was 2.1 (95%CI 1.4-3.2, P=0.004), LAD OR was 1.8 (95%CI 1.2-2.2, P=0.006) and the duration of AF OR was 2.8 (95%CI 1.6-4.0, P=0.007).4. 23 cases were followed up for 9 months in successful electroversion group.5 cases recurred in 3 months, 3 cases recurred in 3 to 6 months, 2 cases recurred in 6 to 9 months. 3 cases in the cases that recurred selected electrical cardioversion, and 2 cases obtained successful electrical cardioversion again. The others controlled ventricular rate by antiarrhythmic. Compared with the unrecurred cases , LAD was no difference (P<0.05), and CRP level was higher (P<0.05) in the recurred cases.Conclusion1. Inflammation, oxidative stress and RAS take part in electrical remodeling and structural remodeling of auricle and correlate with genesis, maintenance and recurrence of atrial fibrillation.2. C-reactive protein level, LAD and the duration of AF were independent factors, which can predict whether the electrical cardioversion could restore sinus rhythm in patients with atrial fibrillation.
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