ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardiac Rhythmology
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1637255
Prognostic value of inflammatory indices for atrial fibrillation recurrence after cryoablation: a cohort study
Provisionally accepted
- 1Nanjing Medical University, Nanjing, China
- 2Nanjing First Hospital, Nanjing, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background: Inflammatory markers have emerged as potential prognostic markers of atrial fibrillation (AF) recurrence following cryoablation. However, comparative analyses of multiple systemic indices are limited. This study aimed to evaluate four inflammation-derived biomarkers—the neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and panimmune-inflammation value (PIV)—for their prognostic value in post-cryoablation AF recurrence. Methods: We conducted a retrospective cohort of 757 patients undergoing first-time cryoablation at Nanjing First Hospital (January 2017–December 2023). We investigated the associations between the four systemic inflammatory markers and AF recurrence. Baseline characteristics were collected from medical records, and inflammatory marker levels were calculated from routine blood tests. Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratios; restricted cubic splines (RCS) assessed potential nonlinearity; and time-dependent receiver operating characteristic (ROC) analyses quantified predictive performance at 12 and 24 months. Results: Compared with tertile 1, tertile 3 showed higher multivariable-adjusted hazards of recurrence (HR: NLR = 4.112, SII = 4.010, SIRI = 5.137, PIV = 5.298; all P < 0.001). The RCS revealed inflection points (logNLR = 1.0, logSII = 6.0), beyond which the risk slopes intensified. Time-dependent ROC analyses showed the highest AUCs for logPIV (AUC = 0.764 at 12 months; 0.741 at 24 months) compared with the other indices (AUC range = 0.715–0.742), with an optimal cutoff yielding 79.2% sensitivity and 68.3% specificity. Conclusion: Systemic inflammation indices—particularly the pan-immune-inflammation value (PIV)—show prognostic association with AF recurrence after cryoablation and may inform preprocedural risk stratification and postablation surveillance. Given the observational design, these findings are associative and do not evaluate whether biomarker-guided selection or management improves outcomes. External calibration and validation—including in radiofrequency (RF) and pulsed-field ablation (PFA) cohorts—are needed to establish generalizability and clinical utility.
Keywords: AtrialFibrillation, Neutrophil-to-lymphocyteratio, SystemicImmune-InflammationIndex, SystemicInflammationResponseIndex, panimmune-inflammation value, Cryoablation, Recurrence
Received: 25 Jun 2025; Accepted: 25 Aug 2025.
Copyright: © 2025 Jie, Chun, Jia, Zhang and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jianping Wang, Nanjing First Hospital, Nanjing, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.