Standard and novel biomarkers as predictors of atrial fibrillation recurrence after cryoablation: a 48-month follow-up in a low-volume center

Q: What are the key findings of this study?

Higher baseline uric acid-to-HDL-cholesterol ratio and BMI independently predicted 48-month AF recurrence after cryoablation.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Symptomatic paroxysmal or persistent atrial fibrillation undergoing cryoablation (n=120). Intervention: Baseline uric acid-to-HDL-cholesterol ratio (UHR) and other standard/novel biomarkers prior to cryoablation vs. Lower baseline biomarker levels / patients without AF recurrence. Primary outcome: Atrial fibrillation recurrence (any documented episode of AF lasting at least 30 seconds after the 3-month blanking period) over 48 months (OR 1.017, 95% CI 1.007-1.026, p=<0.001).

Q: What does this research mean for the field?

Higher levels of BMI, creatinine, NTproBNP, uric acid, uric acid-to-HDL-cholesterol ratio, and triglycerides, along with lower albumin and HDL-C levels, are significant predictors of atrial fibrillation recurrence after cryoablation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To identify clinical, echocardiographic, and laboratory biomarkers that predict atrial fibrillation recurrence following cryoballoon ablation over a 48-month follow-up at a low-volume center.

Mihailo Vukmirović; Irena Tomašević Vukmirović

doi:10.1186/s12872-026-06984-2

November 11, 2026BMC Cardiovascular DisordersOpen Access

Standard and novel biomarkers as predictors of atrial fibrillation recurrence after cryoablation: a 48-month follow-up in a low-volume center

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Key result

Higher uric acid-to-HDL ratio linked to ~2% higher odds of AF recurrence after cryoablation.

OR 1.017
95% CI 1.007-1.026
P<0.001
n=120

Why the study?

This study sought to identify standard and novel biomarkers, along with clinical and echocardiographic parameters, that predict AF recurrence following cryoablation at a low-volume center.

Do baseline standard and novel biomarkers (such as the uric acid-to-HDL-cholesterol ratio and BMI) predict atrial fibrillation recurrence over 48 months in patients undergoing cryoablation?

Key Points

To identify clinical, echocardiographic, and laboratory biomarkers that predict atrial fibrillation recurrence following cryoballoon ablation over a 48-month follow-up at a low-volume center.
Fasting morning blood samples were drawn pre-procedure to evaluate albumin, creatinine, uric acid, lipid profiles, and NTproBNP; recurrence was defined as any documented episode lasting at least 30 s after a 3-month blanking period across 48 months.
During the 48-month follow-up, atrial fibrillation recurrence occurred in 37 of 120 patients (30.8%).
Patients with recurrence had significantly higher median body mass index (28.9 vs 27.0 kg/m²; p<0.001), uric acid (350.0 vs 330.0 µmol/L; p<0.001), creatinine (77.6 vs 71.8 µmol/L; p<0.001), NTproBNP (48 vs 22 pmol/L; p<0.001), and triglycerides (1.6 vs 1.4 mmol/L; p=0.002).
Recurrence was also associated with significantly lower median albumin (40.1 vs 43.2 g/L; p<0.001) and HDL-C levels (1.1 vs 1.2 mmol/L; p=0.007).

Study Design

Type

Cohort (n=120)

Multicenter

No

Structured PICO

Do baseline standard and novel biomarkers (such as the uric acid-to-HDL-cholesterol ratio and BMI) predict atrial fibrillation recurrence over 48 months in patients undergoing cryoablation?

P

Population

120 consecutive adults (mean age 61.9 years, 30.0% female) with symptomatic paroxysmal (35%) or persistent (65%) atrial fibrillation undergoing pulmonary vein isolation via cryoablation at a low-volume center, followed for 48 months.

E

Exposure

Baseline pre-procedural biomarkers (specifically uric acid-to-HDL-cholesterol ratio [UHR], body mass index [BMI], uric acid [UA], creatinine, NT-proBNP, triglycerides, albumin, and HDL-C) measured in a fasting state prior to pulmonary vein isolation via a second-generation 28-mm cryoballoon catheter (180-240 seconds per vein).

O

Outcome

Atrial fibrillation recurrence, strictly defined as any documented episode of AF lasting at least 30 seconds on scheduled 12-lead ECG or 24-hour Holter monitoring after a 3-month blanking period, over 48 months of follow-up.hard clinical

Main Result

Odds Ratio: 1.017 (95% CI 1.007–1.026)

p-value: p=<0.001

Limitations

Retrospective, observational analysis conducted at a single center with a relatively modest cohort (n=120).
Limited sample size within specific clinical subgroups led to wide 95% confidence intervals for certain multivariate predictors such as triglycerides.
Single low-volume center experience, limiting generalizability to tertiary electrophysiology laboratories with different workloads and learning curves.
Post-procedure arrhythmia monitoring relied on scheduled 12-lead ECGs and intermittent 24-hour Holter monitoring rather than continuous implantable cardiac monitors, potentially underestimating asymptomatic or short-term AF recurrence.
Retrospective, observational design at a single center with a modest sample size (n=120)
Limited number of recurrence events (n=37) resulting in wide 95% confidence intervals for some predictors like triglycerides
Low-volume center setting, which may limit generalizability to high-volume tertiary electrophysiology centers
Lack of continuous rhythm monitoring (e.g., implantable loop recorders), relying instead on scheduled 12-lead ECGs and intermittent 24-hour Holter monitoring, which may underestimate asymptomatic AF recurrence

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Implication

Pre-procedural metabolic and renal/cardiac biomarkers—particularly the uric acid-to-HDL-cholesterol ratio (UHR), BMI, creatinine, NT-proBNP, and albumin—independently predict 4-year AF recurrence after cryoballoon ablation and may aid in pre-ablation risk stratification.

Abstract

The aim of this retrospective study was to identify biomarkers, as well as clinical and echocardiographic parameters, as predictors of atrial fibrillation (AF) recurrence following cryoablation at a low-volume center. A retrospective, single-center study was conducted involving 120 patients with paroxysmal or persistent AF. Collected data included laboratory findings, demographic and echocardiographic measurements, comorbidities, and clinical data. Patients were followed for 48 months and recurrence was defined as any documented episode of AF during the follow-up period. Univariate and multivariate logistic regression analyses were performed. During the 48-month follow-up recurrence of AF was observed in 37 patients (30.8%). The mean age of the subjects was 61.9 ± 6.7 years and 70.0% of the participants were male. The majority of patients had persistent AF (65.0%). Univariate and multivariate binary analyses showed that patients with AF recurrence had significantly higher values of body mass index (BMI), uric acid (UA), creatinine, N-terminal pro-B-type natriuretic peptide (NTproBNP), the uric acid-to-HDL-cholesterol ratio (UHR) and triglycerides as well as lower levels of albumin and high-density lipoprotein cholesterol (HDL-C). Biomarkers such as high BMI, creatinine, NTproBNP, UA, UHR and triglycerides, as well as low albumin and HDL-C levels are potentially predictors of AF recurrence after cryoablation. Cryoablation has demonstrated a favorable safety and efficacy profile for paroxysmal and persistent atrial fibrillation in a low-volume center.

Discussion

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Cite This Study

Vukmirović et al. (2026) conducted a cohort in Symptomatic paroxysmal or persistent atrial fibrillation undergoing cryoablation (n=120). Baseline uric acid-to-HDL-cholesterol ratio (UHR) and other standard/novel biomarkers prior to cryoablation vs. Lower baseline biomarker levels / patients without AF recurrence was evaluated on Atrial fibrillation recurrence (any documented episode of AF lasting at least 30 seconds after the 3-month blanking period) over 48 months (OR 1.017, 95% CI 1.007-1.026, p=<0.001). Higher baseline uric acid-to-HDL-cholesterol ratio and BMI independently predicted 48-month AF recurrence after cryoablation.

synapsesocial.com/papers/6af5cd26a40bbe8669e89bce https://doi.org/10.1186/s12872-026-06984-2

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Standard and novel biomarkers as predictors of atrial fibrillation recurrence after cryoablation: a 48-month follow-up in a low-volume center

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Standard and novel biomarkers as predictors of atrial fibrillation recurrence after cryoablation: a 48-month follow-up in a low-volume center

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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