In this presentation Dr. Dernellis talks about the effects of statin therapy on C-reactive protein (CRP), in relation to atrial fibrillation (AF).

Recent findings indicate a mechanistic link between inflammatory processes and the development of AF, and this link may be a target for more effective treatment and prevention strategies. AF causes changes in atrial electrophysiology that promote AF maintenance. Atrial remodelling (electrophysiological and structural alterations that promote the maintenance and re-occurrence of AF), has been linked to inflammation (1).

With regards to CRP, two independent clinical trials were the first to report an association between CRP and AF in non-post-operative patients (2,3). Population based studies have also shown CRP to predict patients at increased risk for the development of future AF. Dr. Dernellis talks about mechanisms which may contribute to the association between increased markers of inflammation and the occurrence of AF, and evidence for an association between CRP-lowering with glucocorticoids and a reduction in recurrent AF (4).

It has also been shown that CRP-lowering with atorvastatin therapy can result in resolution of paroxysmal AF (5). "The treatment effect of atorvastatin exceeds benefits reported for antiarrhythmic drugs," says Dr. Dernellis. The CRP-related incidence of AF was further found to be modified by serum markers of inflammation in a population-based cohort with follow-up data (6). Dr. Dernellis discusses these studies, as well as remaining questions and clinical implications.

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After viewing this presentation, participants will be able to discuss:
- The importance of C-reactive protein in cardiovascular medicine
- Histological findings of inflammation in atrial biopsies in the case of atrial fibrillation
- The role of C-reactive protein in the development of atrial fibrillation
- Effects of anti-inflammatory drugs on recurrent atrial fibrillation
- The pleiotropic properties involved in the anti-arrhythmogenic activity of the statins

1. Andrea Frustaci, MD; Cristina Chimenti, MD; Fulvio Bellocci, MD; Emanuela Morgante, MD; Matteo A. Russo, MD; ; Attilio Maseri, MDHistological Substrate of Atrial Biopsies in Patients With Lone Atrial Fibrillation Circulation. 1997;96:1180-1184.

2. Mina K. Chung, MD; David O. Martin, MD, MPH; Dennis Sprecher, MD; Oussama Wazni, MD; Anne Kanderian, MD; Cynthia A. Carnes, PharmD, PhD; John A. Bauer, PhD; Patrick J. Tchou, MD; Mark J. Niebauer, MD; Andrea Natale, MD; David R. Van Wagoner, PhDC-Reactive Protein Elevation in Patients With Atrial Arrhythmias: Inflammatory Mechanisms and Persistence of Atrial Fibrillation Circulation. 2001;104:2886.

3. Dernellis J, Panaretou M.C-reactive protein and paroxysmal atrial fibrillation: evidence of the implication of an inflammatory process in paroxysmal atrial fibrillation. Acta Cardiol. 2001 Dec;56(6):375-80.

4. Dernellis J, Panaretou M.Relationship between C-reactive protein concentrations during glucocorticoid therapy and recurrent atrial fibrillation Eur Heart J. 2004 Jul;25(13):1100-7.

5. Dernellis J, Panaretou M.Effect of C-reactive protein reduction on paroxysmal atrial fibrillation Am Heart J. 2005 Nov;150(5):1064.

6. Dernellis J, Panaretou M.Effects of C-Reactive Protein and the Third and Fourth Components of Complement (C3 and C4) on Incidence of Atrial Fibrillation The American Journal of Cardiology. Volume 97, Issue 2 , 15 January 2006, Pages 245-248.