U-shaped association of non-HDL-C/HDL-C ratio with atrial fibrillation recurrence postcatheter ablation: a cohort study

Abstract Background The 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. Methods In 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). Results A U-shaped relationship was observed between the NHHR and AF recurrence (P nonlinear =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. Conclusions This 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 registration ChiCTR-OCH-14004674