Usefulness of platelet to lymphocyte ratio for predicting recurrence of atrial fibrillation after direct current cardioversion

Abstract

Objective Atrial fibrillation (AF) is the most common cardiac rhythm disorder with the associated risks of stroke and mortality. The usefulness of platelet to lymphocyte ratio (PLR), a recently described inflammatory marker, in predicting adverse cardiovascular events has been demonstrated in several studies. In the current study, we investigated the role of PLR in predicting recurrence after successful electrical cardioversion (ECV) in patients with non-valvular persistent AF. Methods A total of 287 patients with non-valvular persistent AF achieving restoration of the sinus rhythm after successful ECV were included in this study. At study entry, complete blood count, routine biochemistry tests, and transthoracic echocardiography (TTE) were performed routinely in all subjects. Patients were followed up for 6 months following the procedure and comparisons were performed between patients who recurred and who maintained the sinus rhythm (SR). Results At 6 months of follow-up, AF recurred in 108 patients, corresponding to a recurrence rate of 39%. Mean PLR values in the "AF recurrence group" (mean age 57.4 +/- 12.0 years, 47.6% [n = 80] female) and in "SR maintenance" group (mean age 65.0 +/- 9.4 years, 55.6% [n = 60] female) were 184.8 +/- 44.2 and 103.3 +/- 44.2, respectively, with a significant difference between the two groups (p < 0.001). In multiple regression analyses, PLR emerged as a risk factor associated with AF recurrence during the 6-month follow-up period after successful ECV (odds ratio [OR]: 3.029 (1.013-9.055 95% confidence interval [CI]), p = 0.047). When a cutoff value of 147 was used, the sensitivity and specificity of PLR for predicting AF recurrence were 83.3% and 84.5%, respectively. Conclusion Elevated PLR is a marker of increased inflammation and may serve as a practical and inexpensive predictor for recurrence during 6 months of follow-up in patients with non-valvular persistent AF who had restoration of the sinus rhythm after successful ECV.