High‐density lipoprotein cholesterol to c‐reactive protein ratio predicts atrial fibrillation recurrence after electrical cardioversion

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Abstract Atrial fibrillation (AF) recurrence after cardioversion is common, and inflammation plays a critical role in its pathophysiology. We aimed to elucidate the predictive role of the ratio of high‐density lipoprotein cholesterol to c‐reactive protein (HDL‐C/CRP) as an inflammatory marker in AF recurrence after electrical cardioversion (ECV). We analyzed patients who underwent elective ECV for atrial fibrillation between June 2020 and December 2023. Baseline levels of HDL‐C and CRP were obtained. Ninety‐six patients were included. The median age was 59 years, and 48% were female. Atrial fibrillation recurred after ECV in 56 patients (58%). In the AF recurrence group, CHA2DS2‐VASc score was higher (2 [1–3] vs. 1[0–2]; p = 0.013), left atrial diameter was larger (43 ± 5 vs. 40 ± 6 mm; p = 0.015), and HDL‐C/CRP ratio was lower (5.6 [2.7–13.0] vs. 14.0 [4.8–38.0]; p = 0.003) compared with the sinus rhythm group. Cox regression analysis showed that HDL‐C/CRP was a predictor of AF recurrence at follow‐up (unadjusted HR = 0.97; CI 95%: 0.95–0.99; p = 0.004; adjusted HR = 0.98; CI 95%: 0.96–0.99; p = 0.030). ROC curve showed that HDL‐C/CRP ratio was able to predict AF recurrence after ECV (AUC = 0.68; p = 0.003). Kaplan–Meier analysis showed that patients with baseline HDL‐C/CRP <7.4 had higher AF recurrence (log‐rank test p = 0.013). Our research demonstrated that the lower HDL‐C/CRP ratio predicted AF recurrence after ECV during follow‐up.

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