Predictive value of remnant-like particle cholesterol in the prediction of long-term AF recurrence after radiofrequency catheter ablation

Objective: The relationship between remnant-like particle cholesterol (RLP-C) levels and the progression of atrial fibrillation (AF) is not known. This research aimed to explore the association of RLP-C with long-term AF recurrence events post-radiofrequency catheter ablation (RFCA) of AF.

Methods: In total 320 patients with AF who were subjected to the first RFCA were included in this research. Baseline information and laboratory data of patients were retrospectively collected, and a 1-year follow-up was completed. The follow-up endpoint was defined as an AF recurrence event occurring after 3 months. Afterward, a multivariate Cox regression model was constructed to analyze the risk factors that affect AF recurrence.

Results: AF recurrence occurred in 103 patients (32.2%) within 3-12 months after RFCA. Based on the multivariate Cox regression analysis, Early recurrence (ER) [hazard ratio (HR) =1.57, 95% confidence interval (CI): 1.04-2.36, P = 0.032)], coronary artery disease (CAD) (HR = 2.03, 95% CI: 1.22-3.38, P = 0.006), left atrium anterior-posterior diameter (LAD) (HR = 1.07, 95% CI: 1.03-1.10, P < 0.001), triglyceride (TG) (HR = 1.51, 95% CI: 1.16-1.96, P = 0.002), low-density lipoprotein cholesterol (LDL-C) (HR = 0.74, 95% CI: 0.55-0.98, P = 0.036), and RLP-C (HR = 0.75 per 0.1 mmol/L increase, 95% CI: 0.68-0.83, P < 0.001) were linked to the risk of AF recurrence. Among them, the relationship between RLP-C and AF recurrence was found for the first time. The predictive value of RLP-C for AF recurrence was analyzed utilizing receiver operating characteristic (ROC) curves [area under the curve (AUC) = 0.81, 95% CI: 0.77-0.86, P < 0.001]. Subsequently, the optimal threshold value of RLP-C was determined to be 0.645 mmol/L with a sensitivity of 87.4% and a specificity of 63.6% based on the Youden index. Additionally, Kaplan-Meier analysis indicated a lower AF recurrence rate in the >0.645 mmol/L group than in the ≤0.645 mmol/L group (Log-rank P < 0.001).

Conclusion: Low levels of RLP-C are associated with a higher risk of AF recurrence post-RFCA, suggesting that RLP-C may be a biomarker that helps to identify long-term AF recurrence.