U-shaped Association of Non-HDL-C/HDL-C Ratio with Atrial Fibrillation Recurrence Post-Catheter Ablation: A Cohort Study

BackgroundThe prognostic value of lipid metrics in atrial fibrillation (AF) recurrence following catheter ablation (CA) remains controversial. This study investigated the effectiveness of novel lipid parameter non-high-density lipoprotein-cholesterol (HDL-C)/HDL-C ratio (NHHR) in predicting post-ablation AF recurrence. MethodsIn this cohort study, 1,728 patients with AF undergoing first-time CA at our center (2017- 2020) were stratified by NHHR quartiles (Q1-Q4). The primary outcome was AF recurrence following CA. Logistic regression analysis was used to detect the association between NHHR and major adverse cardio- and cerebrovascular events (MACCEs). ResultsA U-shaped relationship was observed between the NHHR and AF recurrence (Pnonlinear=0.021), with an inflection point at NHHR=2.61. Compared to the optimal range (2.62-3.26), patients with Q1 of NHHR had a 63.6% higher recurrence risk (hazard ratio [HR]=1.636, 95% confidence interval [CI]: 1.235-2.166). In cases with the NHHR < 2.61, the AF recurrence risk decreased with an adjusted HR of 0.715 (95% CI, 0.524-0.977, P = 0.035) for every one unit increment in the NHHR. Subgroup and sensitivity analyses confirmed consistency. NHHR demonstrated no association with MACCEs, underscoring its AF-specific prognostic value. ConclusionsThis study demonstrated a novel U-shaped association between NHHR and AF recurrence following CA. NHHR serves as a robust biomarker for AF recurrence risk stratification post-ablation, reflecting bidirectional lipid pathophysiology beyond atherosclerotic pathways. These findings advocate for NHHR integration into clinical monitoring protocols while cautioning against therapeutic NHHR manipulation without mechanistic validation. Trial registrationChiCTR-OCH-14004674