Inflammatory cell infiltration in left atrial appendageal tissues of patients with atrial fibrillation and sinus rhythm

Christopher Hohmann, Roman Pfister, Martin Mollenhauer, Christoph Adler, Jolanta Kozlowski, Andreas Wodarz, Uta Drebber, Jens Wippermann, Guido Michels, Christopher Hohmann, Roman Pfister, Martin Mollenhauer, Christoph Adler, Jolanta Kozlowski, Andreas Wodarz, Uta Drebber, Jens Wippermann, Guido Michels

Abstract

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in clinical practice and is known to be associated with significant morbidity and mortality. Previous studies suggested a link between inflammation and AF by findings of increased inflammatory markers in AF patients. However, it has not been finally clarified whether inflammation is a systemic or a local phenomenon reflecting an active inflammatory process in the heart. To address this subject, human left atrial appendage tissues were obtained from 10 patients who underwent cardiac surgery and subjected to immunohistochemical analysis. The number of inflammatory CD3-positive T cells significantly increased from patients with sinus rhythm to paroxysmal AF and persistent AF, respectively. Interestingly, in patients with persistent AF, these cells were frequently arranged in small clusters. Subsequently, the number of inflammatory CD3-positive T cells decreased and was significantly lower in patients with permanent AF than in patients with persistent AF. Inflammatory CD20-positive B cells could only be detected very occasionally in all AF subgroups and were not locatable in patients with SR. Hence, our data emphasize the potential prominent role of the cellular component of the immune system in the development and perpetuation of AF.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Immunofluorescent stainings of human tonsil samples for positive control. The DNA binding dye (DAPI, blue) enables visualization of the cellular nucleus, and thereby the cell distribution (a). Localization of CD20-positive B cells (b) and CD3-positive T cells (c) with overlapping expressions (d) are presented.
Figure 2
Figure 2
Frequency of CD3-positive T cells in left atrial appendage tissues of patients with sinus rhythm (SR) or paroxysmal, persistent and permanent atrial fibrillation (AF). Box-plots presenting median and interquartile range of CD3-positive T cells per square mm are given. Adjacent dot plots demonstrate data distribution in each subgroup. The number of inflammatory CD3-positive T cells was significantly higher in patients with paroxysmal AF than in the SR group (p 

Figure 3

Immunofluorescent stainings of human left…

Figure 3

Immunofluorescent stainings of human left atrial appendage tissues for CD3-positive T cells. Sections…

Figure 3
Immunofluorescent stainings of human left atrial appendage tissues for CD3-positive T cells. Sections of left atrial appendage tissues demonstrating the presence of CD3-positive T cells (1 cell, white arrow) in patients with sinus rhythm (a), paroxysmal (3 cells, white arrows) atrial fibrillation (b), peristent (7 cells, white arrow) atrial fibrillation (c) and permanent (4 cells, white arrows) atrial fibrillation (d). Whereas the number of CD3-positive T cells increased from sinus rhythm over paroxysmal atrial fibrillation to persistent atrial fibrillation, cell counts subsequently decreased from persistent to permanent atrial fibrillation.
Figure 3
Figure 3
Immunofluorescent stainings of human left atrial appendage tissues for CD3-positive T cells. Sections of left atrial appendage tissues demonstrating the presence of CD3-positive T cells (1 cell, white arrow) in patients with sinus rhythm (a), paroxysmal (3 cells, white arrows) atrial fibrillation (b), peristent (7 cells, white arrow) atrial fibrillation (c) and permanent (4 cells, white arrows) atrial fibrillation (d). Whereas the number of CD3-positive T cells increased from sinus rhythm over paroxysmal atrial fibrillation to persistent atrial fibrillation, cell counts subsequently decreased from persistent to permanent atrial fibrillation.

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