Predictive value of the systemic immune inflammation index in recurrence of atrial fibrillation after radiofrequency catheter ablation

Abstract

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.

Keywords: APPLE score; Biomarkers; Prediction; Radiofrequency catheter ablation; Recurrent atrial fibrillation; Systemic immune inflammation index.

Figure 1

Plausible role of inflammation as key component of pathophysiological processes leading to AF development and recurrence. AF: Atrial fibrillation; CBBA: Cryo-balloon-based ablation; CRP: C-reactive protein; CV: Cruciferous vegetables; DM: Diabetes mellitus; ECM: Extracellular matrix; FGF: Fibroblast growth factor; GDF: Growth differential factor; IL: Interleukin; Gal-3: Galectin-3; MMPs: Matrix metalloproteinases; RAAS: Renin-angiotensin-aldosterone system; RANKL: Receptor activator of the NF-kappa B ligand; RFCA: Radiofrequency catheter ablation; SII: Systemic immune-inflammation index; SST2: Soluble suppression of tumorigenicity-2; TIMMPs: Tissue inhibitor of matrix metalloproteinases; TGF-beta: Transforming growth factor-beta; TNF: Tumour necrosis factor.