The Predictive Value of Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Lymphocyte-to-Monocyte Ratio for Early Recurrence in Patients with Atrial Fibrillation After Radiofrequency Ablation

Abstract Objective This study aimed to investigate the risk factors associated with early recurrence after radiofrequency catheter ablation for atrial fibrillation (AF). It specifically evaluated the predictive value of multiple inflammatory biomarkers, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR). The goal was to identify potential therapeutic targets to reduce the rate of early post-ablation AF recurrence. Methods This was a retrospective, single-center study that included 267 patients with AF who underwent radiofrequency ablation between 2019 and 2024. The cohort included 114 patients with paroxysmal AF and 153 with persistent AF. All patients were observed for a 3-month period post-procedure to collect clinical and imaging data and to determine recurrence. The collected data included general patient information, clinical history, and laboratory parameters (such as complete blood count and high-sensitivity C-reactive protein). The inflammatory markers NLR, PLR, and LMR were calculated from these results. Echocardiography was used to measure cardiac structural parameters, such as left atrial diameter (LAD) and left ventricular ejection fraction (LVEF). Statistical analysis was used to compare these variables between the recurrence group (n = 79) and the non-recurrence group (n = 188) and to assess the relationship between inflammation and cardiac structure. Results Multivariate logistic regression analysis indicated that PLR, LMR, and absolute monocyte count were independent risk factors for early recurrence after AF ablation. A Receiver Operating Characteristic (ROC) curve analysis based on this predictive model showed an area under the curve (AUC) of 0.9293, indicating high predictive accuracy. Subgroup analysis revealed that patients with persistent AF had a significantly higher rate of early recurrence than patients with paroxysmal AF (37% vs. 20%, respectively). Furthermore, the persistent AF group had significantly higher NLR levels and larger left atrial diameters. A significant correlation was observed between inflammatory markers and changes in cardiac structure. In the overall recurrence group, NLR was significantly positively correlated with LAD (r = 0.657, p < 0.05) and significantly negatively correlated with LVEF (r = − 0.467, p < 0.05). These correlations varied among different AF subtypes, suggesting that NLR, PLR, and LMR are all involved in the process of cardiac remodeling. Conclusion Elevated PLR, LMR, and absolute monocyte count are independent predictors of early AF recurrence after radiofrequency ablation. The higher inflammatory state indicated by these markers is associated with an increased risk of recurrence and is linked to adverse cardiac remodeling. These findings suggest that NLR, PLR, and LMR have potential clinical value in cardiac remodeling and predicting early AF recurrence, can be used for risk stratification, and may become therapeutic targets for managing patients with AF.