Background
Albuminuria is a known marker that increases cardiovascular and renal risk, yet its association with atrial fibrillation (AF) phenotype and arrhythmia recurrence after catheter ablation is not well defined. AF and chronic kidney disease (CKD) frequently coexist. While prior studies linked increased albumin-creatinine ratio (UACR) to a higher risk of developing AF, this study aimed to evaluate the association between albuminuria and early AF recurrence after ablation.
Methods
This is a monocentric retrospective analysis of 351 patients with AF and ablation, in which UACR were obtained. Ablation modalities comprised cryoballoon (43%, n = 149), radiofrequency (38.5%, n = 136), and pulsed-field ablation (18.5%, n = 66). Pre-procedural UACR was measured from spot urine samples, and albuminuria was defined as UACR ≥ 30 mg/g. The primary endpoint was early AF recurrence within 3 months, assessed by systematic 3-day Holter ECG monitoring. Clinical and biochemical parameters, including eGFR, comorbidities, and RAAS-blocking medication, were obtained from medical records.
Results
Median age was 67 years (IQR 61–73), 31% were female, and the median eGFR was 73.8 ml/min/1.73m². Albuminuria was present in 21.9% and increased with AF chronicity: 12,4% in paroxysmal AF (pAF), 30,2% in persistent AF (peAF), and 80,0% in long-standing persistent AF (lspeAF) (p<0.001). Early AF recurrence occurred more frequently in patients with than without albuminuria (41,6% vs. 21,1%, p<0.0001). In subgroup analyses, the association was strongest in peAF (p=0.012). Patients undergoing repeat ablation had higher recurrence rates compared with first-time procedures (33.0% vs. 15.5%, p=0.003), with comparable UACR distributions.
In univariate logistic regression, higher continuous UACR values were associated with early recurrence (OR 1.002 per mg/g, 95% CI 1.000–1.004, p=0.013). In the multivariable model adjusted for age, diabetes, hypertension, heart failure, eGFR, and RAAS blockade, albuminuria remained an independent predictor of early recurrence (OR 2.24, 95% CI 1.21–4.12). Albuminuria increased stepwise with AF phenotype: peAF (OR 3.05, 95% CI 1.73–5.39, p<0.001) and lspeAF (OR 9.26, 95% CI 1.46–114.0, p=0.004).
Conclusion
Albuminuria was independently associated with early AF recurrence after catheter ablation and correlated with disease chronicity. These findings highlight albuminuria as a clinically accessible biomarker reflecting atrial and systemic remodeling. Incorporating albuminuria assessment into pre- and post-procedural evaluation may support individualized risk stratification and guide tailored follow-up strategies in patients undergoing AF ablation.
