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.

Several objective and comprehensive nutritional assessment methods have been used for predicting adverse outcomes in elderly patients with various diseases. However, their predictive value for long-term adverse outcomes in elderly patients with atrial fibrillation (AF) is unclear. This study aimed to explore the prognostic significance of the four nutritional indices, namely Prognostic Nutritional Index (PNI), Geriatric Nutritional Risk Index (GNRI), Controlling Nutritional Status (CONUT), and High-Sensitivity Modified Glasgow Prognostic Score (HS-mGPS), in evaluating the long-term prognosis in elderly patients with AF.

This retrospective study was conducted at a single center and included a total of 261 elderly patients with AF from December 2015 to December 2021. Patients were divided into all-cause death and survival groups based on the follow-up results. Kaplan-Meier analysis and COX regression were conducted to explore the relationship between all-cause mortality and nutritional scores. In addition, Receiver Operating Characteristic (ROC) curves were used to compare the predictive value of the four nutritional screening tools for the endpoint event.

During the follow-up period, 119 cases (45.59%) of all-cause mortality were recorded. The cumulative incidence of all-cause death was significantly higher in participants with a lower PNI, lower GNRI, higher CONUT, and higher HS-mGPS levels. And the low PNI (HR 1.325, 95% CI 1.032-2.857, P=0.025) and the high HS-mGPS (HR 2.166, 95% CI 1.281-4.326, P=0.023) groups were independently and significantly associated with increased risk of all-cause death analyzed by multivariate COX regression. Additionally, PNI showed the best area under the curve value (AUC: 0.696, 95% CI 0.632-0.760 P < 0.001) for the prediction of all-cause mortality compared with the other nutritional indices.

Among the four nutritional risk screening tools, PNI might be a simple and useful indicator in predicting the long-term prognosis of elderly patients with AF.

Atrial fibrillation (AF) is an arrhythmia that affects the left atrium, cardiac function, and the patients' survival rate. Due to empowered diagnostics, it has become increasingly recognized among young individuals as well, in whom it is influenced by a complex interplay of autoimmune, inflammatory, and electrophysiological mechanisms. Deepening our understanding of these mechanisms could contribute to improving AF management and treatment. Inflammation is a complexly regulated process, with interactions among various immune cell types, signaling molecules, and complement components. Addressing circulating antibodies and designing specific autoantibodies are promising therapeutic options. In cardiomyopathies or channelopathies, the first manifestation could be paroxysmal AF; persistent forms tend not to respond to antiarrhythmic drugs in these conditions. Further research, both in vitro and in vivo, on the use of genomic biotechnology could lead to new therapeutic approaches. Additional triggers that can be encountered in AF patients below 60 years of age are systemic hypertension, overweight, diabetes, and alcohol abuse. The aims of this review are to briefly report evidence from basic science and results of clinical studies that might explain the juvenile burden of the most encountered sustained supraventricular tachyarrhythmias in the general population.

Atrial Fibrillation (AF) induces proinflammatory processes which incite vascular endothelial activation and dysfunction. This study seeks to examine the potential relationship between various endothelial, inflammatory, thrombotic, and renin-angiotensin-system (RAS) biomarkers in AF patients.Blood samples were from AF patients (n = 110) prospectively enrolled in this study prior to their first AF ablation. Control plasma samples (n = 100) were used as reference. All samples were analyzed for endothelial (NO, ICAM-1, VEGF, TF, TFPI, TM, Annexin V), inflammatory (IL-6, TNFα, CRP), thrombotic (vWF, tPA, PAI-1, TAFI, D-dimer), and RAS (Renin, Ang-II) biomarkers using ELISA methods. Biomarker average comparisons and Spearman correlations were performed.AF patients showed varying levels of biomarker increase compared to controls. We observed a significant decrease of Ang-II in the AF population relative to controls when stratified for the use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) upon study enrollment. AF patients showed statistically significant correlations between the following biomarkers: TNFα vs IL-6 (rs = 0.317, p = .004), ICAM-1 vs TNFα (rs = 0.527, p = .012), Annexin V vs VEGF (rs = 0.620, p < .001), CRP vs VEGF (rs = 0.342, p = .031), Ang-II vs tPA (rs = -0.592, p = .010), and tPA vs PAI-1 (rs = 0.672, p < .001).Our study demonstrated significant elevation of endothelial, inflammatory, and thrombotic biomarkers in AF patients compared to controls, with significant correlations between these biomarkers in the AF population. Future investigations are required to better elucidate the mechanistic pathways that lead to endothelial dysfunction and thromboinflammation in AF. This may provide novel therapeutic targets, that in addition to current anticoagulation practices, can best curtail thrombogenicity in AF.

The role of lipoprotein(a) (Lp[a]) as a possibly causal risk factor for atherosclerotic cardiovascular disease has been well established. However, the clinical evidence regarding the association between Lp(a) levels and atrial fibrillation (AF) remains limited and inconsistent. This study aimed to analyze the association between elevated Lp(a) levels or single-nucleotide polymorphisms (SNPs) related to high levels of Lp(a) and AF.

This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A literature search was performed to identify studies that evaluated the association between Lp(a) levels or SNPs related to high levels of Lp(a) and AF. Observational studies with a cross-sectional, case-control, or cohort design were included in this systematic review, without limitations according to language, country, or publication type.

Eleven observational studies including 1,246,817 patients were eligible for this systematic review. Two cross-sectional studies, 5 prospective/retrospective cohort studies, and 4 Mendelian randomization studies were analyzed. Two cross-sectional studies that compared Lp(a) levels between patients with and without AF showed conflicting results. Cohort studies that evaluated the incidence of AF according to Lp(a) levels showed different results: no association (3 studies), a positive association (1 study), and an inverse relationship (1 study). Finally, Mendelian randomization studies also showed heterogeneous results (positive association: 2 studies; inverse association: 1 study; no association: 1 study).

Although there could be an association between Lp(a) levels and AF, the results of the studies published to date are contradictory and not yet definitive. Therefore, further research should clarify this issue.