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THE IMPORTANCE OF NITRIC OXIDE AND OXIDATIVE STRESS IN ATRIAL HIGH-RATE EPISODES IN PATIENTS WITH CARDIAC DEVICES

İNANÇ ARTAÇ, METİN ÖĞÜN, TİMOR OMAR, MUAMMER KARAKAYALI, DOĞAN İLİŞ, AYÇA ARSLAN, YAVUZ KARABAĞ, İBRAHİM RENCÜZOĞULLARI

Archives of the Turkish Society of Cardiology - 2024;52(2):81-87

Department of Cardiology, Kafkas University Faculty of Medicine, Kars, Türkiye

 

OBJECTIVE Atrial High Rate Episodes (AHRE) are subclinical atrial tachyarrhythmias detectable by cardiac implantable electronic devices (CIEDs). AHREs have been associated with an increased risk of developing atrial fibrillation (AF), thromboembolism, cardiovascular and cerebrovascular events, and mortality. Although recent studies have assessed the value of oxidative stress markers in patients with AF, the relationships between AHRE and oxidative stress markers, including nitric oxide, has not yet been elucidated. This study aims to investigate the relationship between these markers and AHRE. METHOD This prospective, cross-sectional study comprised 180 patients with CIEDs. The study population was divided into two groups based on the presence (n = 78) and absense (n = 102) of AHRE to analyze its association with biomarkers. RESULTS The AHRE (+) group was significantly older, had a higher prevalence of hypertension, higher NT-proBNP (508.8 ± 249 pg/mL vs. 415.3 ± 292.1; P = 0.037), MDA levels (20.9 ± 4.1 μmol/L vs. 19.1 ± 3.1 μmol/L; P = 0.006), and iNOS activity (1,935.9 ± 326.1 pg/mL vs. 1,677.4 ± 363.2 pg/mL; P < 0.001). Logistic regression analysis identified age, hypertension, MDA (odds ratio [OR]: 1.131, 95%CI: 1.009 - 1.268, P = 0.035), inducible nitric oxide synthase (iNOS) activity (OR = 1.002, 95% CI = 1.001 - 1.003, P < 0.001), and endothelial nitric oxide synthase (eNOS) activity (OR = 0.990, 95% CI = 0.986 - 0.984, P < 0.001) as independent predictors of AHRE. CONCLUSION The study findings indicated that plasma levels of NT-proBNP, MDA, nitric oxide, and the expression of iNOS and eNOS were significantly associated with AHRE. Moreover, elevated plasma MDA concentrations, increased iNOS activity, and decreased eNOS activity were identified as independent predictors of AHRE.