Helicobacter pylori May Be Associated With Increased Risk of Atrial Fibrillation

Laurie Barclay, MD

June 17, 2005

June 17, 2005 — Helicobacter pylori is associated with an increased risk of atrial fibrillation (AF), according to the results of a case-control study published in the July issue of Heart.

"A potential non-cardiovascular disease that predisposes to AF may be chronic gastritis caused by chronic Helicobacter pylori infection," write A.S. Montenero, MD, from Policlinico Multimedica, Sesto San Giovanni in Milan, Italy, and colleagues. "Thus, we hypothesised that H. pylori may be involved in the chronic atrial inflammation resulting in AF."

Between March 2002 and January 2003, the investigators enrolled 59 consecutive patients with a paroxysmal or persistent form of AF who were admitted for cardioversion and electrophysiological study, including some patients without structural heart disease and some who were prescribed medication for hypertension. They compared these patients with a control group of 45 healthy volunteers with no history of atrial arrhythmias or concomitant acute or chronic disease. Patients with myocardial infarction, prior cardiothoracic surgery, ischemic heart disease, valvular disease, thyroid dysfunction, congenital heart disease, diabetes, and acute or chronic infections were excluded.

Both groups were similar in terms of mean age, most traditional risk factors and cholesterol, low-density lipoprotein cholesterol, and triglyceride levels. More patients were being treated for hypertension in the AF group than in the control group. Patients with persistent AF (n = 29) were older than patients with paroxysmal AF (n = 30), and they had a higher prevalence of treated hypertension.

Compared with the control group, the AF group had significantly higher H. pylori seropositivity (97.2 [50.5 - 100.0] IU/mL vs 5.3 [5.0 - 33.9] IU/mL) and C-reactive protein (CRP) (8 [6 - 10] mg/L) vs 1 [0 - 2] mg/L; P < .001) for both comparisons.

After adjustment for differences in age, H. pylori seropositivity and CRP were both significantly higher in patients with persistent AF than in those with paroxysmal AF (100 (72.6 - 100.0) IU/mL vs 60.2 (35.9 - 100.0) IU/mL; P = .027, and 9 (7 - 11) mg/L vs 7 (6 - 10) mg/L; P = .041, respectively).

"The association between AF and H. pylori was very strong in patients with persistent AF," the authors write. "In addition, we report high concentrations of CRP, which confirm the presence of systemic inflammation in patients with AF, which leads us to hypothesise that H pylori infection may be the substrate of this systemic inflammation manifesting in AF.… More data will be necessary from controlled studies to further identify how H. pylori can influence the pathogenesis of AF."

Heart. 2005;91:960-961

Reviewed by Gary D. Vogin, MD

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