J-shape positive association between E/E′ and recurrent atrial fibrillation after radio-frequency catheter ablation: A cohort study in China

The relationship between E/E' and recurrent atrial fibrillation (AF) after radio-frequency catheter ablation (RFCA) remains unclear. This study aimed to investigate the association between the E/E' ratio and recurrent AF after RFCA. A cohort of 278 AF patients undergoing RFCA at the Second Hospital of Hebei Medical University from January 2017 was consecutively enrolled. Baseline clinical and demographic data were collected, with follow-ups (planned: 3, 6, 12, 18 months and every 6 months thereafter; unplanned: symptom-triggered) using 12-lead electrocardiography and 24-hour Holter monitoring to detect recurrent AF (primary endpoint, defined as AF/atrial flutter/tachycardia lasting ≥30 seconds after a 3-month blanking period). Kaplan-Meier analysis estimated recurrent rates; multivariate Cox regression and generalized additive models explored associations between E/E' and recurrent AF, including nonlinear relationships. Over a median follow-up of 15 months, 24.82% of patients developed recurrent AF. The recurrent rate was significantly higher in the high E/E' group (P < .01). After adjustment, the high E/E' group had a 4-fold higher risk of recurrent AF (hazard ratio [HR] = 4.01, 95% confidence interval: 2.12-7.57, P < .01). A J-shaped association was identified, with an inflection point at 10.10: elevated E/E' below 10.10 was not significantly associated with recurrent risk, while each 1-unit increase in E/E' above 10.10 was associated with an 18% higher adjusted HR (HR = 1.18, 95% confidence interval: 1.10-1.26, P < .01). High E/E' was associated with a higher rate of recurrent AF after RFCA. A significant positive association was observed between E/E' and recurrent AF, particularly when E/E' ≥ 10.10.