Comparative Predictive Value of Nine Composite Inflammatory Markers for Atrial Fibrillation Recurrence After Catheter Ablation

Purpose Recurrence of atrial fibrillation (AF) following catheter ablation (CA) is a common clinical challenge in AF management. Chronic inflammation plays a crucial role in the mechanism of AF recurrence. Although preliminary studies have explored the predictive value of composite inflammatory markers for AF recurrence, there remains a notable lack of research that directly compares multiple composite markers simultaneously. This study aims to investigate and compare the associations between nine composite inflammatory markers and the risk of AF recurrence after CA in patients with AF. Patients and Methods This study prospectively included 744 AF patients who underwent their first CA at the Second Affiliated Hospital of Xi’an Jiaotong University between October 2017 and July 2024.We calculated nine composite inflammatory markers from pre-procedure peripheral blood cell counts. After adjusting for confounders, Cox regression, restricted cubic splines (RCS), and receiver operating characteristic (ROC) curves assessed their association with AF recurrence. Sensitivity analysis verified result robustness. Results Higher levels of the Systemic Immune-Inflammation Index (SII), Neutrophil-to-Lymphocyte Ratio (NLR), Systemic Immune-Inflammation Response Index (SIRI), and Pan-Immune-Inflammation Value (PIV) were significantly associated with increased recurrence risk. After full model adjustment, Q4 vs Q1 HRs [95% CIs] were: SII 1.88 (1.23–2.88), NLR 1.85 (1.21–2.84), SIRI 2.03 (1.31–3.14), PIV 1.58 (1.06–2.38), with risk rising as indices increased. The Neutrophil-to-Platelet Ratio (NPR) Q3 risk was higher than Q1 (HR=1.58; 95% CI:1.07–2.32). In terms of prognostic predictive efficacy, NLR demonstrated the best performance among the inflammatory indicators (AUC: 0.62). Sensitivity analysis confirmed each index’s robustness. Conclusion The SII, NLR, SIRI, NPR, and PIV may serve as valuable biomarkers for AF recurrence, among which NLR exhibits superior predictive capability compared to the other indices. These markers should be considered in clinical risk stratification and hold promise for providing new strategies and directions to reduce the recurrence rate.