Plasma von Willebrand factor, fibrinogen and soluble P-selectin levels in paroxysmal, persistent and permanent atrial fibrillation - Effects of cardioversion and return of left atrial function

Background Atrial fibrillation is associated with increased risk of stroke and thromboembolism, possibly by conferring a prothrombotic or hypercoagula ble state. However, it is unclear whether or not this differs in the clinic al subgroups of chronic atrial fibrillation patients, that is, in those wit h paroxysmal, persistent or permanent atrial fibrillation. We therefore hyp othesized that: (i) there are differences in the prothrombotic state betwee n these patients; and (ii) reduction in indices of hypercoagulability would follow elective electrical cardioversion of persistent atrial fibrillation and the return of left atrial function. Patients and Methods We studied 69 patients with chronic atrial fibrillatio n: 23 with paroxysmal atrial fibrillation (16 males; mean age 65 years +/- SD 13); 23 with persistent atrial fibrillation (16 males; 65 years 13), wit h a mean duration of atrial fibrillation of 3 months (range 2 to 6 months); and 23 with permanent atrial fibrillation (16 males; 67 years +/- 10). Blo od results were compared to 20 age- and sex-matched healthy controls. The p atients with persistent atrial fibrillation then underwent elective DC card ioversion, with Doppler echocardiographic examinations and bloods tests per formed prior to cardioversion, and at 3 and 12 weeks afterwards. The prothr ombotic state was quantified by measurement of plasma levels of fibrinogen, soluble P-selectin (an index of platelet activation) and von Willebrand fa ctor (a marker of endothelial dysfunction). Results Permanent atrial fibrillation was associated with significantly rai sed levels of von Willebrand factor, soluble P-selectin and fibrinogen (all P<0.001); paroxysmal atrial fibrillation with significantly elevated level s of plasma von Willebrand factor (P=0.0067) and fibrinogen (P=0.0001) but not soluble P-selectin (P=0.472); and persistent atrial fibrillation with n ormal levels of fibrinogen, von Willebrand factor and soluble P-selectin wh en compared to healthy controls (all P=ns). Stepwise multiple regression an alyses demonstrated that the presence of atrial fibrillation was an indepen dent predictor of abnormal von Willebrand factor, fibrinogen and soluble P- selectin levels. Electrical cardioversion of the patients with persistent a trial fibrillation did not significantly alter levels of von Willebrand fac tor (P=0.766), soluble P-selectin (P=0.726) or fibrinogen (P=0.50) despite maintenance of sinus rhythm and a significant return of left atrial systoli c function (as quantified by the presence of A wave on Doppler echocardiogr aphy) at 3 months. Conclusion There were significant differences in the prothrombotic state wh en patients with paroxysmal and permanent atrial fibrillation are compared to matched patients with persistent atrial fibrillation or controls in sinu s rhythm. Cardioversion of persistent atrial fibrillation did not significa ntly alter indices of hypercoagulability even after 3 months maintenance of sinus rhythm, despite the return of atrial systole.