Relationship between the Stress–Hyperglycemia Ratio and Atrial Fibrillation Recurrence Risk After Radiofrequency Catheter Ablation: A Retrospective Study

Mengli LI¹Ning-Jun Zhu¹Zhen Wang¹Ting-ting Fan¹Xiaochen Wang¹Xun Yang^2*

• ¹The Affiliated Second Hospital of Anhui Medical University, Hefei, China
• ²The First Affiliated Hospital of Anhui Medical University, Hefei, China

Background The stress hyperglycemia ratio (SHR) is linked to cardiovascular outcomes. However, its role in predicting atrial fibrillation (AF) recurrence after radiofrequency catheter ablation (RFCA) remains unclear. Therefore, this study investigated the SHR as a potential prognostic biomarker for post-RFCAAF recurrence. Methods In this retrospective cohort study, 446 symptomatic non-valvular atrial fibrillation patients who underwent radiofrequency catheter ablation were followed for 12 to 26 months. The stress hyperglycemia ratio (SHR) was calculated as admission fasting blood glucose (mmol/L) / [1.59 × HbA1c (%) - 2.59]. Patients were classified based on SHR levels. The primary endpoint was atrial fibrillation recurrence, and the secondary endpoints were cardiovascular events and a composite endpoint comprising relevant clinical outcomes. Results AF recurrence occurred in 128 patients (28.7%). Patients in the recurrence group exhibited significantly higher SHR levels (p < 0.001). Receiver operating characteristic (ROC) analysis identified an optimal SHR cutoff value of 0.91 for predicting recurrence. Furthermore, even after multivariable adjustment for diabetes, alcohol consumption, antiarrhythmic drug use, SGLT2 inhibitor use, left atrial diameter (LAD), and uric acid levels, elevated SHR remained significantly associated with AF recurrence (HR: 3.379, 95% CI: 2.272–5.025, P < 0.001). ROC analysis demonstrated that SHR had superior predictive performance compared with other glycemic parameters, with an area under the curve (AUC) of 0.79 (95% CI: 0.74–0.84), yielding a sensitivity of 79.7% and a specificity of 68.4%. A prognostic nomogram incorporating six independent predictors was developed to estimate 1-and 2-year recurrence-free survival. Formal interaction tests indicated no significant effect modification by diabetes status (P for interaction = 0.432), with consistent SHR-associated recurrence risks observed in both diabetic and non-diabetic subgroups. Sensitivity analyses confirmed the robustness of these findings, as statistical significance was maintained after excluding patients with prior open-heart surgery and when modeling SHR as tertiles. Conclusions The increase in SHR is significantly correlated with atrial fibrillation recurrence and composite events after RFCA. These findings support its potential clinical application value in improving risk stratification and prognostic assessment of this patient population.