The Prevalence of Atrial Fibrillation in Patients with Congestive Heart Failure and Hypogammaglobulinemia

Background: Atrial Fibrillation (AF), a common disorder in patients with congestive heart failure (CHF), has recently been linked to inflammation. Immune system perturbances have been reported in CHF and we have recently noted that some patients with end-stage CHF exhibit evidence of hypogammaglobulinemia (HGG). This study was undertaken to evaluate the prevalence of AF in CHF patients with HGG. We hypothesized that HGG is associated with reduced prevalence of AF. Methods: We evaluated 344 CHF patients (mean age = 53 years, mean left ventricular EF = 19%) who were listed for heart transplantation (status 1 and 2). IgG level is routinely determined in our institution, as baseline, at the time of listing. Patients on plasmapheresis were excluded from the study. Fifty eight patients (16.8%) had evidence of HGG defined by IgG level less than 700 mg/dl (HGG group). These patients were compared to the remaining cohort (n = 286, Control). The prevalence of AF (pre-transplant) was compared in the 2 populations. All patients underwent heart transplantation and post-transplant AF was also compared. Results: The baseline characteristics were similar in both groups except for a lower serum protein in the HGG group as previously observed. The prevalence of AF (pre-transplant) in the overall CHF population was 40.7% (140/344). The prevalence of AF in the HGG group was significantly reduced compared with Control {25.8% (15/58) versus 43.7% (125/286), P = 0.013}. However, post-transplant, 7/58 (12.1%) in the HGG group and 45/286 (15.7%) experienced AF within 2 weeks of transplant (P = NS). Interestingly, persistence of AF (AF present at pre and post transplant) trended to be lower in the HGG group compared with Control {3.4% (2/58) versus 9.8% (28/286), P = 0.1} Conclusions: HGG in CHF patients is associated with a lower prevalence of AF. This may be related to the suppressed immune system, and hence, possible suppressed inflammatory state in hypogammaglobulinemic patients. Large prospective studies are required to further elucidate the mechanisms and links involved between HGG and AF in the CHF population. Background: Atrial Fibrillation (AF), a common disorder in patients with congestive heart failure (CHF), has recently been linked to inflammation. Immune system perturbances have been reported in CHF and we have recently noted that some patients with end-stage CHF exhibit evidence of hypogammaglobulinemia (HGG). This study was undertaken to evaluate the prevalence of AF in CHF patients with HGG. We hypothesized that HGG is associated with reduced prevalence of AF. Methods: We evaluated 344 CHF patients (mean age = 53 years, mean left ventricular EF = 19%) who were listed for heart transplantation (status 1 and 2). IgG level is routinely determined in our institution, as baseline, at the time of listing. Patients on plasmapheresis were excluded from the study. Fifty eight patients (16.8%) had evidence of HGG defined by IgG level less than 700 mg/dl (HGG group). These patients were compared to the remaining cohort (n = 286, Control). The prevalence of AF (pre-transplant) was compared in the 2 populations. All patients underwent heart transplantation and post-transplant AF was also compared. Results: The baseline characteristics were similar in both groups except for a lower serum protein in the HGG group as previously observed. The prevalence of AF (pre-transplant) in the overall CHF population was 40.7% (140/344). The prevalence of AF in the HGG group was significantly reduced compared with Control {25.8% (15/58) versus 43.7% (125/286), P = 0.013}. However, post-transplant, 7/58 (12.1%) in the HGG group and 45/286 (15.7%) experienced AF within 2 weeks of transplant (P = NS). Interestingly, persistence of AF (AF present at pre and post transplant) trended to be lower in the HGG group compared with Control {3.4% (2/58) versus 9.8% (28/286), P = 0.1} Conclusions: HGG in CHF patients is associated with a lower prevalence of AF. This may be related to the suppressed immune system, and hence, possible suppressed inflammatory state in hypogammaglobulinemic patients. Large prospective studies are required to further elucidate the mechanisms and links involved between HGG and AF in the CHF population.