Circulating intermediate monocytes and toll-like receptor 4 correlate with low-voltage zones in atrial fibrillation
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ORIGINAL ARTICLE
Circulating intermediate monocytes and toll‑like receptor 4 correlate with low‑voltage zones in atrial fibrillation Hideya Suehiro1 · Koji Fukuzawa1,2 · Naofumi Yoshida1 · Kunihiko Kiuchi1,2 · Mitsuru Takami1 · Tomomi Akita1 · Tokiko Tabata1 · Makoto Takemoto1 · Jun Sakai1 · Toshihiro Nakamura1 · Atsusuke Yatomi1 · Hiroyuki Takahara1 · Yusuke Sonoda1 · Kazutake Nakasone1 · Kyoko Yamamoto1 · Atsushi Suzuki3 · Tomoya Yamashita1 · Ken‑ichi Hirata1,2 Received: 20 April 2020 / Accepted: 5 June 2020 © Springer Japan KK, part of Springer Nature 2020
Abstract Inflammation has been suggested to play a key role in the pathogenesis of atrial fibrillation (AF). Our hypothesis was that this inflammation, mediated by intermediate monocytes and toll-like receptor 4 (TLR4), causes the formation and expansion of low-voltage zones (LVZs). Prior to ablation, the monocyte subsets of 78 AF patients and TLR4 expression of 66 AF patients were analyzed via a flow cytometric analysis. Based on the CD14/CD16 expression, the monocytes were divided into three subsets: classical, intermediate, and non-classical. At the beginning of the ablation session, voltage mapping was performed. LVZs were defined as all bipolar electrogram amplitudes of 0.3 mg/dl], 5 to structural heart disease, 4 to malignancy, 10 to being prescribed amiodarone or bepridil, and 9 because the voltage mapping was unclear. In addition, 7 patients, suffering from an AF rhythm when the mapping procedure was begun, which failed to either regain or maintain SR despite multiple DC shocks, were, therefore, excluded. The baseline characteristics and clinical data (for all subjects, without LVZs vs. with LVZs) are summarized in Table 1. LVZs were detected in 39 patients (50%), including 23 of 52 PAF patients and 16 of 26 non-PAF patients. Patients with LVZs were significantly older and more likely to be female. The BNP and CRP levels were significantly higher and the eGFR, TG levels, FPG levels, and LAA flow velocity significantly lower in the patients with LVZs. Cytometric analysis of the monocyte subsets The mean monocyte count and relative proportions of the different monocyte subsets are shown in Table 1. No significant differences were observed in the mean monocyte count or proportion of non-classical monocytes between the patients with LVZs and those without LVZs. However,
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patients with LVZs had a significantly higher proportion of intermediate monocytes (10.0 ± 3.6% vs. 7.2 ± 2.7%, respectively, p
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