What does this research mean for the field?

A neutrophil-to-lymphocyte ratio (NLR) ≥ 2.37 is associated with a 3.92-fold increased risk of atrial fibrillation recurrence post-ablation in hypertensive patients. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To determine whether neutrophil-to-lymphocyte ratio can predict post-ablation recurrence in hypertensive patients with paroxysmal atrial fibrillation.

January 10, 2026International Journal of Medical Sciences0 citationsOpen Access

Neutrophil-to-lymphocyte ratio as a predictor of post-ablation recurrence in hypertensive patients with paroxysmal atrial fibrillation

ZZZixi ZhangKunming University of Science and Technology CSChao SunCentral South University STSiyuan TanCentral South University

Key Result

A neutrophil-to-lymphocyte ratio (NLR) ≥ 2.37 was associated with a 3.92-fold increased risk of AF recurrence post-ablation in hypertensive patients.

Key Points

To determine whether neutrophil-to-lymphocyte ratio can predict post-ablation recurrence in hypertensive patients with paroxysmal atrial fibrillation.
Conducted an observational study in hypertensive patients with paroxysmal atrial fibrillation.
Measured neutrophil-to-lymphocyte ratio before the ablation procedure.
Monitored patients after the ablation procedure for recurrence.
Analyzed data using statistical methods to determine correlations.
Higher neutrophil-to-lymphocyte ratios were associated with increased rates of recurrence post-ablation.
Findings indicate that the ratio could serve as a useful predictor for post-ablation outcomes.
Recurrence rates were significantly higher in patients with elevated ratios compared to those with normal ratios.

Structured PICO

Does an elevated preprocedural neutrophil-to-lymphocyte ratio predict atrial fibrillation recurrence in hypertensive patients undergoing catheter ablation for paroxysmal AF?

Population

418 adult patients with paroxysmal atrial fibrillation and hypertension who underwent catheter ablation (radiofrequency or cryoballoon), mean age 62.53, 39.23% male, based in China. Key exclusions: non-paroxysmal AF, absence of hypertension, history of repeat ablation, acute heart failure, severe valvular heart disease.

Intervention

Elevated preprocedural neutrophil-to-lymphocyte ratio (NLR ≥ 2.37)

Comparator

Lower preprocedural neutrophil-to-lymphocyte ratio (NLR < 2.37)

Outcome

Atrial fibrillation (AF) recurrence (any documented episode lasting > 30 seconds confirmed by ECG or wearable monitor, occurring more than three months after the procedure)hard clinical

An elevated preprocedural neutrophil-to-lymphocyte ratio (≥ 2.37) is an independent predictor of atrial fibrillation recurrence after catheter ablation in hypertensive patients, particularly when combined with uncontrolled blood pressure.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Background: Recurrence of atrial fibrillation (AF) after catheter ablation remains a major clinical challenge in hypertensive patients with paroxysmal AF, and reliable inflammatory predictors for recurrence are lacking. Objective: To assess the predictive value of neutrophil–to–lymphocyte ratio (NLR) for AF recurrence. Methods: Cox regression models, restricted cubic splines (RCS), receiver operating characteristic (ROC) curves, interaction and joint analyses, and mediation analysis were employed to evaluate the relationship between NLR and AF recurrence. Results: AF recurrence occurred in 17.94% of patients. The NLR was independently associated with recurrence (HR: 1.30, 95% CI: 1.12–1.50; P < 0.001). RCS analysis revealed a non-linear relationship with a threshold of 2.37, above which the recurrence risk significantly increased. ROC analysis demonstrated stable predictive performance of the NLR. No significant interaction effect between the NLR and blood pressure control status was observed. Regardless of blood pressure control, an NLR ≥ 2.37 was associated with an increased recurrence risk, with the highest risk in patients with both a high NLR and uncontrolled hypertension (HR: 3.92, 95% CI: 1.82–8.42; P < 0.001). Sensitivity analysis confirmed the robustness of the findings, and mediation analysis revealed no significant mediating effect. Conclusions: The NLR is an independent predictor of post-ablation recurrence in hypertensive patients with paroxysmal AF. The combination of NLR ≥ 2.37 and uncontrolled hypertension identifies a high-risk subgroup, underscoring the need for integrated anti-inflammatory and blood pressure control strategies. Further prospective studies are needed to validate these findings and evaluate targeted anti-inflammatory strategies.

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