Immunopathogenesis and biomarkers of recurrent atrial fibrillation following ablation therapy in patients with preexisting atrial fibrillation

John H. Rosenberg, John H. Werner, Gilman D. Plitt, Victoria V. Noble, Jordan T. Spring, Brooke A. Stephens, Aleem Siddique, Helenmari L. Merritt-Genore, Michael J. Moulton, Devendra K. Agrawal

Research output: Contribution to journalReview articlepeer-review

9 Scopus citations


Introduction: Recurrent atrial fibrillation (RAF) following ablation therapy occurs in about 50% of patients. The pathogenesis of RAF is unknown, but is believed to be driven by atrial remodeling in the setting of background inflammation. Structural, electrophysiological and mechanical remodeling has been associated with atrial fibrillation (AF). Inflammation and fibrotic remodeling are the major factors perpetuating AF, as mediators released from the atrial tissues and cardiomyocytes due to mechanical and surgical injury could initiate the inflammatory process. In this article, we have critically reviewed the key mediators that may serve as potential biomarkers to predict RAF. Areas covered: Damage associated molecular patterns, heat shock proteins, inflammatory cytokines, non-inflammatory markers, markers of inflammatory cell activity, and markers of collagen deposition and metabolism are evaluated as potential biomarkers with molecular treatment options in RAF. Expert commentary: Establishing biomarkers to predict RAF could be useful in reducing morbidity and mortality. Investigations into the role of DAMPs participating in a sterile immune response may provide greater insight into the pathogenesis of RAF. Markers evaluating immune cell activity, collagen deposition, and levels of heat shock proteins show the greatest promise as potential biomarkers to predict RAF and develop novel therapies.

Original languageEnglish (US)
Pages (from-to)193-207
Number of pages15
JournalExpert review of cardiovascular therapy
Issue number3
StatePublished - Mar 4 2019


  • Arrhythmia
  • atrial fibrillation
  • danger associated molecular patterns
  • fibrosis
  • heat shock proteins
  • inflammation
  • surgical ablation

ASJC Scopus subject areas

  • Internal Medicine
  • Cardiology and Cardiovascular Medicine


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