Conventional and Emerging Biomarkers for Predicting Post-Ablation Atrial Fibrillation Recurrence: An Updated Systematic Review

Q: What is the clinical evidence from this study?

Study design: Systematic Review. Population: Atrial Fibrillation (n=26702). Intervention: Circulating biomarkers (e.g., BMP-10, homocysteine, TyG index, CA-125, natriuretic peptides) vs. Normal or lower baseline biomarker levels. Primary outcome: Late atrial fibrillation recurrence (documented atrial arrhythmia lasting ≥ 30 seconds occurring after a 3-month post-ablation blanking period).

Q: What does this research mean for the field?

Circulating biomarkers, particularly bone morphogenetic protein-10, homocysteine, triglyceride glucose index, and natriuretic peptides, demonstrate strong and consistent predictive value for atrial fibrillation recurrence following catheter ablation. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Naveed Mohsin; Martin E. Matsumura; Tariq Ahmad; Kaif Ul Sahar; Lubna Mohammed

doi:10.14740/cr2231

August 25, 2026Cardiology ResearchOpen Access

Conventional and Emerging Biomarkers for Predicting Post-Ablation Atrial Fibrillation Recurrence: An Updated Systematic Review

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Key result

Novel circulating biomarkers strongly predict late AF recurrence after catheter ablation.

n=26,702

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Why the study?

Atrial fibrillation recurrence after catheter ablation remains common and difficult to predict using conventional clinical risk models, prompting evaluation of circulating biomarkers for improved risk stratification.

Do conventional and emerging circulating biomarkers predict late atrial fibrillation recurrence in patients undergoing catheter ablation?

Key Points

To provide an updated systematic review evaluating conventional and emerging circulating biomarkers associated with post-ablation atrial fibrillation recurrence.
Conducted a systematic review per PRISMA 2020 guidelines across PubMed/Medline, Cochrane Library, ScienceDirect, Europe PubMed Central, and Google Scholar for studies published between January 2020 and March 2025.
Included 27 studies comprising 26,702 participants (cohort sizes ranging from 42 to 10,085) with follow-up periods of 12 to 36 months evaluating 30 biomarkers after catheter ablation.
Synthesized findings qualitatively due to marked clinical and methodological heterogeneity in biomarker assays, effect size metrics, atrial fibrillation subtypes, and adjustment models.
Atrial fibrillation recurrence rates ranged from 15.7% to 51% across cohorts over 12 to 36 months of follow-up.
Stronger and more consistent predictors identified in larger cohorts included bone morphogenetic protein-10 (BMP-10), homocysteine, triglyceride glucose index, plasma carbohydrate antigen-125, N-terminal pro-B-type natriuretic peptide, and mid-regional pro-atrial natriuretic peptide.
Emerging markers including high mobility group box 1, trimethylamine-N-oxide, and lipopolysaccharide showed high predictive potential in smaller cohorts, whereas conventional inflammatory markers (C-reactive protein and high-sensitivity C-reactive protein) displayed weaker or inconsistent associations.

Study Design

Type

Systematic Review (n=26,702)

Structured PICO

Do conventional and emerging circulating biomarkers predict late atrial fibrillation recurrence in patients undergoing catheter ablation?

P

Population

26,702 participants with atrial fibrillation who underwent catheter ablation, evaluated across 27 studies for conventional and emerging biomarkers predicting arrhythmia recurrence over 12 to 36 months of follow-up.

E

Exposure

Measurement of circulating conventional and emerging biomarkers reflecting inflammation, myocardial remodeling, metabolic dysfunction, and neurohormonal activation (e.g., BMP-10, TMAO, TyG index, CA-125, NT-proBNP, MR-proANP) either pre- or post-catheter ablation to predict risk of recurrence.

C

Comparator

Lower or normal baseline/post-procedural levels of the evaluated biomarkers, varying by study (e.g., lower quartiles/tertiles or established cut-offs).

O

Outcome

Late AF recurrence, defined as any documented atrial arrhythmia (AF, atrial flutter, or atrial tachycardia lasting ≥ 30 s) occurring after a 3-month post-ablation blanking period.

Emerging biomarkers reflecting metabolic stress, myocardial remodeling, and neurohormonal activation demonstrate stronger and more consistent predictive value for post-ablation atrial fibrillation recurrence than conventional inflammatory markers.

Limitations

Substantial clinical and methodological heterogeneity across studies, including differences in biomarker assays and effect size reporting, precluded quantitative meta-analysis.
Geographic concentration of cohorts in East Asia, particularly China, potentially limits generalizability to other populations.
Variability in timing of biomarker assessment (pre-ablation vs. post-ablation) may reflect different mechanisms such as baseline substrate versus procedural injury.
Most studies evaluating emerging biomarkers were single-center investigations with relatively small sample sizes.
Lack of formal evaluation of incremental predictive value beyond established clinical and echocardiographic parameters.
Observational design of primary studies limits causal inference and leaves associations susceptible to residual confounding.
Substantial clinical and methodological heterogeneity across studies precluding a quantitative meta-analysis
Geographic concentration of cohorts in East Asia (China), limiting generalizability
Variability in timing of biomarker assessment (pre-ablation vs. immediate post-procedural)
Heterogeneity in assay platforms, laboratory calibration standards, and reported thresholds
Small sample sizes and single-center designs for most studies evaluating emerging biomarkers
Observational design of included studies with residual confounding limiting causal inference

Implication

May aid post-ablation AF recurrence risk stratification; extends predictive value beyond conventional clinical models.

Abstract

Background: Atrial fibrillation (AF) recurrence after catheter ablation remains common and difficult to predict using conventional clinical risk models. Circulating biomarkers reflecting inflammation, myocardial remodeling, metabolic dysfunction, and neurohormonal activation may improve risk stratification. This systematic review provides an updated synthesis of conventional and emerging biomarkers associated with post-ablation AF recurrence. Methods: This systematic review was conducted in accordance with PRISMA 2020 guidelines. A comprehensive search of databases (PubMed/Medline, Cochrane Library, ScienceDirect, Europe PubMed Central, and Google Scholar) was performed for studies published between January 2020 and March 2025. Eligible studies included observational cohorts, systematic reviews and meta-analyses evaluating biomarkers associated with AF recurrence after catheter ablation with ≥ 12 months follow-up. Eligible studies were critically appraised using appropriate quality assessment tools. Due to heterogeneity in study design, biomarker measurement, and effect reporting, a qualitative synthesis was performed. Results: A total of 27 studies encompassing 26,702 participants and 30 biomarkers were included. AF recurrence rates ranged from 15.7% to 51% over follow-up periods of 12-36 months. Stronger predictors identified in larger cohorts included bone morphogenetic protein-10 (BMP-10), homocysteine, triglyceride glucose index, and plasma carbohydrate antigen-125. Among natriuretic peptides, N-terminal pro-B-type natriuretic peptide and mid-regional pro-atrial natriuretic peptide demonstrated strong associations. Emerging biomarkers such as high mobility group box 1, trimethylamine-N-oxide, and lipopolysaccharide showed high predictive potential but were supported by smaller cohorts. Conventional inflammatory markers, including C-reactive protein (CRP), high-sensitivity CRP, and interleukin, demonstrated weaker or inconsistent associations. Overall, biomarker performance varied by mechanistic category, study size, and timing of measurement. Conclusions: Multiple conventional and emerging biomarkers are associated with AF recurrence following catheter ablation with metabolic, remodeling, and natriuretic biomarkers demonstrating the strongest and more consistent predictive value. Integration of these biomarkers into clinical risk models may enhance prognostication. Further large-scale, standardized studies are required to validate their clinical utility and facilitate translation into routine practice.

Discussion

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Cite This Study

Mohsin et al. (2026) conducted a systematic review in Atrial Fibrillation (n=26,702). Circulating biomarkers (e.g., BMP-10, homocysteine, TyG index, CA-125, natriuretic peptides) vs. Normal or lower baseline biomarker levels was evaluated on Late atrial fibrillation recurrence (documented atrial arrhythmia lasting ≥ 30 seconds occurring after a 3-month post-ablation blanking period). Multiple circulating biomarkers, particularly bone morphogenetic protein-10, homocysteine, triglyceride glucose index, and natriuretic peptides, demonstrated strong and consistent associations with late atrial fibrillation recurrence following catheter ablation.

synapsesocial.com/papers/6ad0fcc53afa093ea9acffa2 https://doi.org/10.14740/cr2231

Topics

Atrial fibrillation

Persistent AF management

AF ablation outcomes

Anticoagulation in AF

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Conventional and Emerging Biomarkers for Predicting Post-Ablation Atrial Fibrillation Recurrence: An Updated Systematic Review

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

Conventional and Emerging Biomarkers for Predicting Post-Ablation Atrial Fibrillation Recurrence: An Updated Systematic Review

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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