Preprocedural hs-CRP Level Predicts Long-Term Outcomes After First Radiofrequency Ablation in Patients With Non-Valvular Atrial Fibrillation: Insights From the China-AF Cohort

BACKGROUND: Catheter ablation restores sinus rhythm in atrial fibrillation (AF), but long-term cardiovascular risk remains incompletely defined. The prognostic value of high-sensitivity C-reactive protein (hs-CRP) after ablation is uncertain. OBJECTIVE: To investigate the association between preprocedural hs-CRP levels and long-term cardiovascular outcomes after AF ablation. METHODS: We analyzed 4,612 patients with nonvalvular AF undergoing first-time radiofrequency ablation in the prospective China-AF Registry (2011-2023), with a median follow-up of 5.0 years. Baseline hs-CRP was measured using a high-sensitivity immunoturbidimetric assay and analyzed as log-transformed continuous values and tertiles. The primary endpoint was a composite of cardiovascular death and ischemic stroke. Secondary endpoints included life-threatening bleeding, AF recurrence, and cardiovascular readmission. Cox models adjusted for demographic factors, comorbidities, AF type, and medications. RESULTS: Higher baseline hs-CRP was independently associated with increased risk of the primary endpoint (adjusted HR 1.21, 95% CI 1.10-1.33; P<0.001) with a significant dose-response relationship across tertiles. The association was stronger in patients aged <65 years (interaction P=0.006) and remained significant in patients without AF recurrence (HR 1.26, P=0.006). Elevated hs-CRP was also associated with higher risk of cardiovascular readmission. Associations with life-threatening bleeding and AF recurrence were weaker CONCLUSIONS: Preprocedural hs-CRP independently predicts long-term cardiovascular death and ischemic stroke after AF ablation, even in patients without recurrence. These findings support inflammation-based risk stratification beyond rhythm outcomes.