The recurrence of atrial fibrillation(AF)in patients after successful radiofrequency catheter ablation(RFCA)appears to be an unresolved clinical issue and needs to be clearly elucidated.There are many factors associat...The recurrence of atrial fibrillation(AF)in patients after successful radiofrequency catheter ablation(RFCA)appears to be an unresolved clinical issue and needs to be clearly elucidated.There are many factors associated with AF recurrence,such as duration of AF,male sex,concomitant heart failure,hemodynamic parameters,chronic obstructive pulmonary disease,hypertension,obstructive sleep apnea,hyperthyroidism,smoking and obesity.However,the inflammatory changes are strongly associated with electrical and structural cardiac remodeling,cardiac damage,myocardial fibrotic changes,microvascular dysfunction and altered reparative response.In this context,biomarkers reflecting the different stages of AF pathogenesis deserve thorough investigation.The authors of the retrospective study revealed that one-year recurrence rate of non-valvular AF in the high systemic immune inflammation(SII)index group was significantly increased compared to that of the low SII index group and provided additional predictive value to the APPLE.Furthermore,the authors suggest that this biomarker may help physicians to optimize the selection of AF patients and to develop a personalized treatment approach.In conclusion,the SII index may serve as a valuable indicator of recurrent AF in patients after RFCA and may be a biomarker with plausible predictive value for poor clinical outcomes.展开更多
Atrial fibrillation(AF)is the most common arrhythmia in humans,affecting more than 40 million people worldwide.Radiofrequency catheter ablation(RFCA)was first introduced as a treatment for AF by Haïssaguerre M in...Atrial fibrillation(AF)is the most common arrhythmia in humans,affecting more than 40 million people worldwide.Radiofrequency catheter ablation(RFCA)was first introduced as a treatment for AF by Haïssaguerre M in the late 1990s.This procedure quickly became the treatment of choice,especially for symptomatic patients with AF refractory to medication.However,up to 45%of patients may experience AF recurrence within 12 months after RFCA.In this setting,AF recurrence is likely multifactorial,including atrial remodeling,local fibrosis or incomplete ablation due to failure in locating the trigger.Additionally,patients with obesity,sleep apnea,hypertension,or diabetes are at an increased risk of AF recurrence after RFCA.Inflammation is increasingly recognized as a potential key factor in AF recurrence and may arise both from the healing response of heart tissue post-ablation or from chronic low-grade inflammation,as observed in many risk factors.Here,we present an original study by Wang et al,which investigated the combination of the systemic immune-inflammation index-a marker developed to assess overall inflammatory status-and the APPLE score,designed to predict AF recurrence following RFCA.The study found that using both indicators together improved the accuracy of AF recurrence prediction.These findings underscore the significant role of inflammation in cardiovascular disease and demonstrated its impact on AF recurrence after RFCA.Further research is warranted to validate the combined use of these two scores in clinical settings for predicting AF recurrence following catheter ablation.展开更多
BACKGROUND Radiofrequency catheter ablation(RFCA)has become an important strategy for treating atrial fibrillation(AF),and postoperative recurrence represents a significant and actively discussed clinical concern.The ...BACKGROUND Radiofrequency catheter ablation(RFCA)has become an important strategy for treating atrial fibrillation(AF),and postoperative recurrence represents a significant and actively discussed clinical concern.The recurrence after RFCA is considered closely related to inflammation.Systemic immune inflammation index(SII)is a novel inflammation predictor based on neutrophils,platelets,and lymphocytes,and is considered a biomarker that comprehensively reflects the immune inflammatory status of the body.AIM To explore the predictive effect of the SII on AF recurrence after RFCA and its predictive value in combination with the existing APPLE score for AF recurrence after RFCA in patients with non-valvular AF(NVAF).METHODS We retrospectively included 457 patients with NVAF first receiving RFCA and classified them into the recurrent or non-recurrent group.We also investigated the predictive role of SII on AF recurrence following RFCA.Finally,we explored and compared the additional predictive value of the SII after combining with the APPLE score.RESULTS After 12 months of follow-up,113(24.7%)patients experienced recurrence.High SII has been demonstrated to be an independent predictor for postoperative AF recurrence.Receiver operating characteristic and decision curve analysis(DCA),as well as net reclassification improvement(NRI)and integrated discrimination improvement(IDI)results,showed that SII combined with the APPLE score had higher predictive efficiency than using the SII or APPLE score alone.The area under the curve of the combined model(0.662,95%confidence interval:0.602-0.722)significantly increased compared with that of the SII and APPLE scores alone(P<0.001).The combined model resulted in an NRI of 29.6%and 34.1%and IDI of 4.9%and 3.5%in predicting AF recurrence compared with the SII and APPLE scores alone,respectively(all P<0.001).The SII,APPLE score,and their combination demonstrated greater clinical utility than did the treat-all and treat-none strategies over the 20–80%risk threshold according to the DCA.CONCLUSION The SII was a predictor of recurrence after RFCA of AF.Moreover,the SII enhanced the predictability of the APPLE score for post-RFCA AF recurrence,providing valuable insights for physicians to optimise patient selection and develop personalised treatment plans.展开更多
文摘The recurrence of atrial fibrillation(AF)in patients after successful radiofrequency catheter ablation(RFCA)appears to be an unresolved clinical issue and needs to be clearly elucidated.There are many factors associated with AF recurrence,such as duration of AF,male sex,concomitant heart failure,hemodynamic parameters,chronic obstructive pulmonary disease,hypertension,obstructive sleep apnea,hyperthyroidism,smoking and obesity.However,the inflammatory changes are strongly associated with electrical and structural cardiac remodeling,cardiac damage,myocardial fibrotic changes,microvascular dysfunction and altered reparative response.In this context,biomarkers reflecting the different stages of AF pathogenesis deserve thorough investigation.The authors of the retrospective study revealed that one-year recurrence rate of non-valvular AF in the high systemic immune inflammation(SII)index group was significantly increased compared to that of the low SII index group and provided additional predictive value to the APPLE.Furthermore,the authors suggest that this biomarker may help physicians to optimize the selection of AF patients and to develop a personalized treatment approach.In conclusion,the SII index may serve as a valuable indicator of recurrent AF in patients after RFCA and may be a biomarker with plausible predictive value for poor clinical outcomes.
文摘Atrial fibrillation(AF)is the most common arrhythmia in humans,affecting more than 40 million people worldwide.Radiofrequency catheter ablation(RFCA)was first introduced as a treatment for AF by Haïssaguerre M in the late 1990s.This procedure quickly became the treatment of choice,especially for symptomatic patients with AF refractory to medication.However,up to 45%of patients may experience AF recurrence within 12 months after RFCA.In this setting,AF recurrence is likely multifactorial,including atrial remodeling,local fibrosis or incomplete ablation due to failure in locating the trigger.Additionally,patients with obesity,sleep apnea,hypertension,or diabetes are at an increased risk of AF recurrence after RFCA.Inflammation is increasingly recognized as a potential key factor in AF recurrence and may arise both from the healing response of heart tissue post-ablation or from chronic low-grade inflammation,as observed in many risk factors.Here,we present an original study by Wang et al,which investigated the combination of the systemic immune-inflammation index-a marker developed to assess overall inflammatory status-and the APPLE score,designed to predict AF recurrence following RFCA.The study found that using both indicators together improved the accuracy of AF recurrence prediction.These findings underscore the significant role of inflammation in cardiovascular disease and demonstrated its impact on AF recurrence after RFCA.Further research is warranted to validate the combined use of these two scores in clinical settings for predicting AF recurrence following catheter ablation.
基金grateful for the clinical data provided by the Department of Cardiology of Weifang People’s Hospital.
文摘BACKGROUND Radiofrequency catheter ablation(RFCA)has become an important strategy for treating atrial fibrillation(AF),and postoperative recurrence represents a significant and actively discussed clinical concern.The recurrence after RFCA is considered closely related to inflammation.Systemic immune inflammation index(SII)is a novel inflammation predictor based on neutrophils,platelets,and lymphocytes,and is considered a biomarker that comprehensively reflects the immune inflammatory status of the body.AIM To explore the predictive effect of the SII on AF recurrence after RFCA and its predictive value in combination with the existing APPLE score for AF recurrence after RFCA in patients with non-valvular AF(NVAF).METHODS We retrospectively included 457 patients with NVAF first receiving RFCA and classified them into the recurrent or non-recurrent group.We also investigated the predictive role of SII on AF recurrence following RFCA.Finally,we explored and compared the additional predictive value of the SII after combining with the APPLE score.RESULTS After 12 months of follow-up,113(24.7%)patients experienced recurrence.High SII has been demonstrated to be an independent predictor for postoperative AF recurrence.Receiver operating characteristic and decision curve analysis(DCA),as well as net reclassification improvement(NRI)and integrated discrimination improvement(IDI)results,showed that SII combined with the APPLE score had higher predictive efficiency than using the SII or APPLE score alone.The area under the curve of the combined model(0.662,95%confidence interval:0.602-0.722)significantly increased compared with that of the SII and APPLE scores alone(P<0.001).The combined model resulted in an NRI of 29.6%and 34.1%and IDI of 4.9%and 3.5%in predicting AF recurrence compared with the SII and APPLE scores alone,respectively(all P<0.001).The SII,APPLE score,and their combination demonstrated greater clinical utility than did the treat-all and treat-none strategies over the 20–80%risk threshold according to the DCA.CONCLUSION The SII was a predictor of recurrence after RFCA of AF.Moreover,the SII enhanced the predictability of the APPLE score for post-RFCA AF recurrence,providing valuable insights for physicians to optimise patient selection and develop personalised treatment plans.
