The Relationship Between Serum Uric Acid/creatinine Ratio (UCR) And The Risk Of AF Recurrence After Radiofrequency Ablation

BackgroundAtrial fibrillation(AF)is one of the most common tachycardiac arrhythmias in clinic,which is easily complicated by thromboembolic events,heart failure and other diseases.Radiofrequency catheter ablation(RFCA)is the interventional therapy for AF recommended by current guidelines,but it has a high recurrence rate,reducing or even avoiding the recurrence of AF after Radiofrequency ablation has important clinical significance.Clinical studies have found a strong association between high uric acid and new onset AF,but the association between uric acid and the risk of postoperative AF recurrence remains controversial.Uric acid/creatinine ratio(UCR)has become a new biomarker,which indicates the level of serum uric acid after renal function standardization,and can better reflect the level of endogenous uric acid.UCR is closely related to many metabolic diseases,however,there are few reports about UCR and the risk of recurrence after AF surgery.Objectives1.To investigate the relationship between UCR and the risk of atrial fibrillation recurrence after catheter ablation.2.To investigate whether UCR is better than serum uric acid in predicting the risk of postoperative recurrence of atrial fibrillation.MethodsIn this historical cohort study,a total of 233 consecutive patients with medically refractory atrial fibrillation who underwent radiofrequency catheter ablation for the first time between January 1,2018 and May 1,2021 were included.All patients were operated successfully by the same group.The procedure was circumferential pulmonary vein isolation.No obvious complications occurred during and after catheter ablation.All patients’ detailed medical history related to cardiovascular and general conditions before ablation were collected.Serum uric acid(SUA),serum creatinine(SCr),white blood cell count(WBC),neutrophil count(NEUT),homocysteine(HCY),total cholesterol(TC),triglyceride(TG),low-density lipoprotein(LDL-C)and glycated hemoglobin(HbA1c)were measured by routine laboratory methods within 2 weeks before ablation.Patients’ color doppler ultrasound of the heart before ablation were collected.Patients’ 12-lead ECG or 24-hour Holter monitor were collected before discharge,3 months after ablation,and twice a year thereafter,and telephone follow-up was performed every 6 months,if the patient is symptomatic,a new ECG recording is performed.The follow-up period was at least 12 months.Recurrence was defined as atrial fibrillation,atrial flutter,or atrial tachycardia with a duration of at least 30 seconds,as confirmed by ECG recordings more than 3 months after AF ablation.Results1.The patients were divided into four groups according to the preoperative UCR level,after a mean follow-up of 23.99±0.76 months,the number of recurrent cases from the lowest UCR group to the highest accounted for the proportion of the total recurrent cases were 10.9%、23.6%、23.6%and 41.8%respectively(P=0.005),the recurrence rate of AF in each group accounted for the proportion of this group was 10.3%,22.4%,22.8%,38.3%(P=0.005).Multivariate Cox regression analysis showed that UCR was an independent predictor of postoperative recurrence of AF(HR 1.217.95%CI 1.008-1.468;P=0.041).2.Subgroup analysis showed that UCR was associated with type of paroxysmal AF(HR 1.426,95%CI 1.092-1.861:P=0.009)and postoperative recurrence in male patients(HR 1.407,95%CI 1.015-1.950;P=0.040).3.According to the ROC curve,the AUC for UCR was 0.651(95%CI:0.568～0.733,P=0.001),higher than that of AF subtypes(AUC:0.590,95%CI:0.501-0.680,P=0.046)and serum UA(AUC:0.601,95%CI:0.516-0.686,P=0.024).The cut-off point of UCR was 4.475,with a sensitivity of 65.5%and a specificity of 59.6%for predicting AF recurrence(P=0.001).Conclusions1.UCR was significantly associated with the risk of AF recurrence after radiofrequency ablation,and UCR is a better predictor of AF recurrence risk than UA.2.UCR is a valuable predictive biomarker of AF recurrence in patients with paroxysmal AF and in male patients with AF.3.UCR levels can effectively identify people at high risk of AF recurrence after radiofrequency ablation.For hyperuricemia patients,uric acid-lowering therapy may be an effective measure to reduce the risk of recurrence after AF surgery.