Tirandi A, Carbone F, Liberale L, Montecucco F. Evaluating inflammatory status to predict atrial fibrillation recurrence following ablation: The role of systemic immune-inflammation index. World J Cardiol 2025; 17(3): 103074 [DOI: 10.4330/wjc.v17.i3.103074]
Corresponding Author of This Article
Fabrizio Montecucco, MD, PhD, Professor, First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 Viale Benedetto XV, Genoa 16132, Liguria, Italy. fabrizio.montecucco@unige.it
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Amedeo Tirandi, Center for Molecular Cardiology, University of Zurich, Schlieren 8952, Zürich, Switzerland
Amedeo Tirandi, Federico Carbone, Luca Liberale, Fabrizio Montecucco, First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa 16132, Liguria, Italy
Author contributions: Tirandi A wrote the paper and drew the image; Liberale L, Carbone F and Montecucco F supervised the entire work; all authors read the final version of the manuscript and approved it for submission and publication.
Conflict-of-interest statement: Liberale L is coinventor on the International Patent WO/2020/226993 filed in April 2020; the patent relates to the use of antibodies which specifically bind interleukin-1a to reduce various sequelae of ischemia-reperfusion injury to the central nervous system. Liberale L has received financial support from the Swiss Heart Foundation and the Novartis Foundation for Medical-Biological Research outside of this work. Tirandi A, Carbone F, and Montecucco F have no conflict of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fabrizio Montecucco, MD, PhD, Professor, First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 Viale Benedetto XV, Genoa 16132, Liguria, Italy. fabrizio.montecucco@unige.it
Received: November 12, 2024 Revised: March 6, 2025 Accepted: March 12, 2025 Published online: March 26, 2025 Processing time: 134 Days and 15 Hours
Abstract
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.
Core Tip: Atrial fibrillation (AF) recurrence may occur in more than one-third of patients after radiofrequency catheter ablation. Identifying patients at higher risk of recurrence allows for closer monitoring of those at high risk. The APPLE score has already been validated for this purpose. However, inflammation appears to play a crucial role in AF recurrence in this context. Wang et al combined the systemic immune inflammation index with the APPLE score showing a better predictivity of AF recurrence after ablation.
