To Örebro University

Background: Atrial fibrillation (AF) is associated with significant morbidity and healthcare burden. While some patients remain asymptomatic, others experience debilitating symptoms. Traditional factors such as heart rate and rhythm irregularity do not fully explain this variability, suggesting that additional mechanisms, including inflammation, contribute to symptom severity.

Purpose: We aimed to investigate inflammation-associated protein profiles in patients with symptomatic AF before and after ablation compared to controls.

Methods: This case-control study included 100 patients aged 18–75 years with symptomatic paroxysmal or persistent AF scheduled for a first catheter ablation (pulmonary vein isolation) and 100 age- and sex-matched controls without AF. Symptom burden was assessed using the AF6 questionnaire (score range 0-60) and the modified European Heart Rhythm Association (EHRA) symptom scale. Peripheral blood samples were collected from AF patients both before and the day after ablation, and once from controls. Proteomic profiling was performed using the Olink Target 96 Inflammation panel. In addition, six AF-related proteins—Cystatin C, N-terminal pro B-type natriuretic peptide (NT-proBNP), high-sensitivity (hs) C-reactive protein (CRP), cancer antigen 125 (CA-125), hs troponin, and S100-calcium binding protein B (S100B)—were analysed separately. Principal component analysis and linear regression models (adjusted for baseline value, age, sex, rhythm at admission, baseline creatinine, and baseline NT-proBNP) were used to examine biomarker profiles, with significance defined as p<0.05 after Bonferroni correction.

Results: The median AF6 sum score was 23 (IQR: 14-32), and most patients were classified as EHRA III, indicating severe symptoms before ablation. Fifty-two inflammatory biomarkers, including interleukin-6, fibroblast growth factor-21, and interleukin-10 were significantly increased after compared to before ablation. Principal component analysis showed partial separation between AF patients (both pre- and post-ablation) and controls, indicating distinct inflammatory profiles, with some overlap between pre- and post-ablation (Figure 1). Among the six targeted proteins, all were elevated except S100B. In the case-control comparison, 12 biomarkers were significantly increased in AF patients, and NT-proBNP and Cystatin C were elevated in the separate analysis. Twenty-three patients experienced at least one ECG-verified AF recurrence between the end of the three-month blanking period and the six-month follow-up.

Conclusion: Our findings indicate that symptomatic AF is associated with a distinct inflammatory biomarker signature that is further modified by catheter ablation. These results highlight an acute inflammatory response and potential immune modulation post-ablation, underscoring the potential of inflammatory biomarkers in refining personalised management strategies for patients with symptomatic AF.

OBJECTIVE: Most patients with atrial fibrillation (AF) report symptoms, while one-third are asymptomatic. We hypothesised that sensory processing, in particular pain, differs in patients with symptomatic and asymptomatic AF.

METHODS: Thirty individuals with permanent AF (15 symptomatic and 15 asymptomatic) completed the Atrial Fibrillation 6 (AF6) and short form 36 Health Survey questionnaires and underwent quantitative pain sensitisation testing using pressure algometry at the sternum (referred pain area) and the tibialis anterior muscle (generalised pain area). The primary objective was to assess differences in pressure pain thresholds (PPT), temporal summation of pain (TSP) and conditioned pain modulation (CPM) in the two groups. The secondary objective was to determine association of demographic and clinical parameters to measures of pain sensitisation.

RESULTS: The symptomatic group had lower PPTs at both tibialis (p=0.004) and sternum (p=0.01), and impaired CPM (p=0.025) and facilitated TSP (p=0.008) at the tibialis but not sternum, compared with the asymptomatic group. The AF6 sum score was negatively correlated to PPT on both tibialis (r=-0.50, p=0.005) and sternum (r=-0.42, p=0.02) and positively correlated to TSP on both tibialis (r=0.57, p=0.001) and sternum (r=0.45, p=0.01), but not to CPM. The physical component summary score was positively correlated to the PPT on both tibialis (r=0.52, p=0.003) and sternum (r=0.40, p=0.03) and negatively to TSP on the tibialis (r=-0.53, p=0.003) but not sternum.

CONCLUSIONS: Patients with symptomatic AF exhibit lower pain tolerance than patients with asymptomatic AF, as well as impaired pain inhibitory control and facilitated summation of pain, indicating that pain sensitisation may be of importance in symptomatic AF.Trial registration numberNCT04649437.

Background/Introduction: Most patients with atrial fibrillation (AF) report symptoms, while around one-third are asymptomatic. We hypothesized that sensory processing, in particular pain, differs in patients with symptomatic and asymptomatic AF.

Purpose: To assess differences in pain sensitisation in patients with symptomatic and asymptomatic AF.

Methods: Thirty individuals with permanent AF (15 symptomatic, 15 asymptomatic) completed the AF6 and SF-36 questionnaires and underwent quantitative pain sensitisation testing using pressure algometry at the sternum (referred pain area) and the tibialis anterior muscle (generalized pain area). The primary objective was to assess differences in pressure pain thresholds (PPT), temporal summation of pain (TSP), and conditioned pain modulation (CPM) in the two groups. The secondary objective was to determine association of demographic and clinical parameters to quantitative measures of pain sensitisation.

Results: The symptomatic group had lower PPTs at both tibialis (p=0.004) and sternum (p=0.01), as well as impaired CPM (p=0.025) and facilitated TSP (p=0.008) at the tibialis but not sternum, compared to the asymptomatic group. The AF6 sum score was negatively correlated to PPT on both tibialis (r=−0.50, p=0.005) and sternum (r=−0.42, p=0.02) and positively correlated to TSP of both tibialis (r=0.57, p=0.001) and sternum (r=0.45, p=0.01), but not to CPM. The physical component summary score was positively correlated to the PPT on both tibialis (r=0.52, p=0.003) and sternum (r=0.40, p=0.03) and negatively to TSP on the tibialis (r=−0.53, p=0.003) but not sternum.

Conclusions: Patients with symptomatic AF exhibit lower pain tolerance than patients with asymptomatic AF, as well as impaired pain inhibitory control and facilitated summation of pain, indicating that pain sensitisation may be of importance in symptomatic AF.

Background: Atrial fibrillation (AF) is the most common sustained arrhythmia affecting an estimated 3 % of the adult population in the western world. The prevalence of the disease increases with increasing age, thought to be due to structural changes in the heart as a result of ageing, long-term hypertension, or organic heart disease. The disorder increases the risk of thromboembolism with the most common manifestation surfacing as a stroke. Oral anticoagulants such as novel oral anticoagulants or vitamin K antagonists are an essential preventative measure for strokes and are recommended by Socialstyrelsen and European cardiology guidelines. Patients with a high stroke risk not being treated according to these guidelines constitute a high-risk group of individuals. Patients who are contraindicated anticoagulants can undergo a left atrial appendage occlusion to reduce the risk of a stroke.

Aim: To investigate anticoagulation treatment and symptoms of all patients aged 20 years and above with the diagnosis AF at Kumla Health Centre in Örebro county between 2015 and 2018.

Method: This care quality cohort study was based on all patients aged 20 years and above with the diagnosis AF at Kumla Health Centre. Data regarding their type of AF (paroxysmal, persistent or permanent), current medication, relevant comorbidities and risk factors for a stroke according to CHA2DS2-VASc score were obtained from the Medrave 4 database. The patients’ diagnoses were verified using records of their electrocardiograms. Patients were asked to fill out a validated symptom-questionnaire (AF-6) relating to their symptoms of AF. Data was collected and analysed using descriptive statistics.

Results: 34 out of 456 (7.5 %) patients at Kumla Health Centre displayed a high stroke risk and were also missing relevant treatment according to current guidelines. When accounting for contraindications for oral anticoagulation, there were 24 (5.3 %) eligible patients who did not have satisfactory treatment. The prevalence of AF in Kumla was estimated to be 2.1 %, permanent AF was the most common subtype (63.4 %), followed by paroxysmal (31.8 %) and finally persistent (4.8 %). 26 patients were offered a consultation with a cardiologist and 16 out of 24 eligible (66.7 %) for anticoagulation agreed to an updated treatment plan.

Conclusion: The vast majority of patients at Kumla Health Centre with an AF diagnosis were being treated according to current guidelines. The most common type of AF was permanent, and the least common was persistent. Most of the patients who were offered a consultation updated their treatment plan.