Elevated neutrophil-to-lymphocyte ratio (NLR) was associated with an 85% increased risk of atrial fibrillation recurrence after catheter ablation (HR 1.85, 95% CI 1.21–2.84).
Cohort (n=744)
No
Do elevated pre-procedural composite inflammatory markers predict atrial fibrillation recurrence in patients undergoing their first catheter ablation?
Pre-procedural composite inflammatory markers, particularly the Neutrophil-to-Lymphocyte Ratio (NLR), are significant predictors of atrial fibrillation recurrence following catheter ablation.
Effect estimate: HR 1.85 (95% CI 1.21–2.84) for highest vs lowest quartile of NLR (95% CI 1.21-2.84)
p-value: p=0.005
Purpose: Recurrence of atrial fibrillation (AF) following catheter ablation (CA) is a common clinical challenge in AF management. Chronic inflammation plays a crucial role in the mechanism of AF recurrence. Although preliminary studies have explored the predictive value of composite inflammatory markers for AF recurrence, there remains a notable lack of research that directly compares multiple composite markers simultaneously. This study aims to investigate and compare the associations between nine composite inflammatory markers and the risk of AF recurrence after CA in patients with AF. Patients and Methods: This study prospectively included 744 AF patients who underwent their first CA at the Second Affiliated Hospital of Xi’an Jiaotong University between October 2017 and July 2024.We calculated nine composite inflammatory markers from pre-procedure peripheral blood cell counts. After adjusting for confounders, Cox regression, restricted cubic splines (RCS), and receiver operating characteristic (ROC) curves assessed their association with AF recurrence. Sensitivity analysis verified result robustness. Results: Higher levels of the Systemic Immune-Inflammation Index (SII), Neutrophil-to-Lymphocyte Ratio (NLR), Systemic Immune-Inflammation Response Index (SIRI), and Pan-Immune-Inflammation Value (PIV) were significantly associated with increased recurrence risk. After full model adjustment, Q4 vs Q1 HRs 95% CIs were: SII 1.88 (1.23– 2.88), NLR 1.85 (1.21– 2.84), SIRI 2.03 (1.31– 3.14), PIV 1.58 (1.06– 2.38), with risk rising as indices increased. The Neutrophil-to-Platelet Ratio (NPR) Q3 risk was higher than Q1 (HR=1.58; 95% CI:1.07– 2.32). In terms of prognostic predictive efficacy, NLR demonstrated the best performance among the inflammatory indicators (AUC: 0.62). Sensitivity analysis confirmed each index’s robustness. Conclusion: The SII, NLR, SIRI, NPR, and PIV may serve as valuable biomarkers for AF recurrence, among which NLR exhibits superior predictive capability compared to the other indices. These markers should be considered in clinical risk stratification and hold promise for providing new strategies and directions to reduce the recurrence rate. Keywords: atrial fibrillation, radiofrequency catheter ablation, inflammation, composite inflammatory markers, risk
Ji et al. (Sun,) conducted a cohort in Adults aged ≥18 years with atrial fibrillation undergoing first radiofrequency catheter ablation (n=744). Measurement of composite inflammatory markers prior to catheter ablation including SII, NLR, PLR, LMR, NPR, SIRI, PAR, PIV, HALP vs. Lower quartile levels of inflammatory markers was evaluated on Recurrence of atrial fibrillation or atrial arrhythmia >30 seconds after 3-month blanking period following catheter ablation (HR 1.85 (95% CI 1.21–2.84) for highest vs lowest quartile of NLR, 95% CI 1.21-2.84, p=0.005). Elevated neutrophil-to-lymphocyte ratio (NLR) was associated with an 85% increased risk of atrial fibrillation recurrence after catheter ablation (HR 1.85, 95% CI 1.21–2.84).