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. 2025 Jan 31;20(1):e0317721.
doi: 10.1371/journal.pone.0317721. eCollection 2025.

The risk of malnutrition as a predictor of arrhythmia recurrence after catheter ablation in patients with paroxysmal non-valvular atrial Fibrillation and heart failure with preserved ejection fraction

Affiliations

The risk of malnutrition as a predictor of arrhythmia recurrence after catheter ablation in patients with paroxysmal non-valvular atrial Fibrillation and heart failure with preserved ejection fraction

Zixi Zhang et al. PLoS One. .

Abstract

Background: Malnutrition presents a significant challenge in managing patients with atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF), yet its impact on AF recurrence after catheter ablation in this population remains unclear.

Methods: We conducted a retrospective analysis of 204 patients with paroxysmal non-valvular AF and HFpEF who underwent radiofrequency or cryoballoon ablation. Risk of malnutrition as assessed using three screening tools: the Controlling Nutritional Status (CONUT) score, Prognostic Nutritional Index (PNI), and Nutritional Risk Index (NRI)]. We examined the relationship between risk of malnutrition and AF recurrence post-ablation.

Results: After a mean follow-up period of 11.2 ± 1.8 months, 43 patients (21.1%) experienced AF recurrence. Despite being classified as overweight or obese based on body mass index, many patients were at risk of malnutrition according to the CONUT score, NRI, and PNI. Adjusted analyses showed that higher CONUT scores (HR: 10.132; 95% CI: 2.545-40.336; P = 0.001), lower NRI (HR: 22.734; 95% CI: 6.399-80.776; P < 0.001), or lower PNI (HR: 9.469; 95% CI: 3.232-27.739; P < 0.001) were significantly associated with increased risk of AF recurrence. Restricted cubic spline regression revealed an inverted U-shaped relationship between the CONUT score and AF recurrence, and L-shaped relationships for both NRI and PNI with AF recurrence.

Conclusions: Systematic nutritional assessment is crucial in patients with paroxysmal non-valvular AF and HFpEF. High CONUT scores, low NRI, or low PNI serve as independent predictors for AF recurrence. Further large-scale randomized controlled trials are required to validate these findings.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Study flowchart.
AF, atrial fibrillation; CONUT, controlling nutritional status; ECG, electrocardiogram; HF, heart failure; HFmrEF, heart failure with mildly reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; NRI, nutritional risk index; PNI, prognostic nutritional index; TTE, transthoracic echocardiography.
Fig 2
Fig 2. Comparison of baseline nutritional status between the AF recurrence group and the non-AF recurrence group.
AF, atrial fibrillation; CONUT, controlling nutritional status; NRI, nutritional risk index; PNI, prognostic nutritional index; Rec, recurrence; SR, sinus rhythm.
Fig 3
Fig 3. ROC curves of the CONUT score, NRI, and PNI for predicting recurrence of AF.
AF, atrial fibrillation; CONUT, controlling nutritional status; NRI, nutritional risk index; PNI, prognostic nutritional index; ROC, receiver operating characteristic.
Fig 4
Fig 4. Kaplan–Meier survival curves of AF recurrence according to the CONUT (A), NRI (B), and PNI (C) scoring systems.
AF, atrial fibrillation; CONUT, controlling nutritional status; NRI, nutritional risk index; PNI, prognostic nutritional index.
Fig 5
Fig 5. Restricted cubic spline regression for the associations between three nutritional screening tools and AF recurrence.
Blue lines represent the HR, and blue transparent areas represent the 95% CI. (A) Association between CONUT score and AF recurrence; (B) Association between NRI and AF recurrence; (C) Association between PNI and AF recurrence. AF, atrial fibrillation; CI, confidence interval; CONUT, controlling nutritional status; HR, hazard ratio; NRI, nutritional risk index; PNI, prognostic nutritional index.

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