Serum Uric Acid to High-Density Lipoprotein Cholesterol Ratio: A Novel Biomarker for Predicting Atrial Fibrillation Recurrence After Cryoablation

Inflammatory factors are closely related to the recurrence of atrial fibrillation (AF) after cryoablation. The objective of this study was to assess the potential of the serum uric acid (UA) to high-density lipoprotein cholesterol (HDL-C) ratio (UHR) for post-cryoablation AF recurrence. Among 519 patients diagnosed with nonvalvular AF who received cryoablation at the Shanghai Tenth People’s Hospital, individuals were categorized into four groups according to their UHR quartiles. Multivariate logistic regression was employed to identify the independent factors predicting AF recurrence post-cryoablation. Subgroup analyses were conducted according to AF type. Kaplan–Meier analysis was used to evaluate the AF-free survival of patients during follow-up. ROC curves were employed to determine the predictive value of the UHR index for AF recurrence post-cryoablation. As UHR quartiles increased from lowest to highest, patients showed progressively decreasing HDL-C levels ([Formula: see text] [Formula: see text]mmol/L versus [Formula: see text] [Formula: see text]mmol/L versus [Formula: see text] [Formula: see text]mmol/L versus [Formula: see text] [Formula: see text]mmol/L, [Formula: see text]), increasing UA values ([Formula: see text]mol/L versus [Formula: see text]mol/L versus [Formula: see text]mol/L versus [Formula: see text]mol/L, [Formula: see text]), and a higher incidence of AF recurrence (3.88% versus 9.92% versus 17.69% versus 61.24%, [Formula: see text]). Persistent AF ([Formula: see text], 95% CI: 1.394–6.426, [Formula: see text]) and UHR ([Formula: see text], 95% CI: 1.012–1.019, [Formula: see text]) were identified as independent predictors of AF recurrence post-cryoablation. A clear trend across increasing UHR quartiles was observed for AF recurrence (P for [Formula: see text]). ROC analysis revealed a UHR cutoff point of 413.46, which exhibited a sensitivity of 60.0% and specificity of 95.7% in predicting AF recurrence. The ROC curve for UHR had an area under the curve (AUC) of 0.880 (95% CI: 0.820–0.940, [Formula: see text]) for late AF recurrence and 0.803 (95% CI: 0.745–0.860, [Formula: see text]) for extremely late AF recurrence. Decision curve analysis (DCA) showed a wide threshold range (0.02–0.95) with significant net clinical benefits for practical application. Our findings suggest UHR as a novel and reliable predictor of AF recurrence after cryoablation, including both late and extremely late recurrence, thereby offering valuable insights for clinical practice.