Cardiometabolic and Endocrine Correlates of Left Atrial Scar in Patients Undergoing Atrial Fibrillation Ablation

ABSTRACT Background Atrial fibrillation (AF) is increasingly conceptualized as a manifestation of atrial cardiomyopathy characterized by progressive fibrosis and structural remodeling. Systemic inflammation may contribute to AF progression and pathogenesis. Elevated inflammatory biomarkers may represent a pro‐inflammatory state, playing a possible role in AF. Left atrial (LA) scar burden serves as a surrogate for atrial fibrosis; however, its association with inflammatory markers is less well established. Objectives The objectives of the study are as follows: To evaluate a possible association between LA scar burden and inflammatory markers. To identify additional markers correlated with higher scar burden. Methods We retrospectively analyzed patients undergoing first‐time AF ablation to explore the association between systemic inflammatory markers and LA scar burden. Biomarkers included high‐sensitivity C‐reactive protein (hsCRP), neutrophil‐to‐lymphocyte ratio (NLR), and N‐terminal pro‐brain natriuretic peptide (NT‐proBNP). Demographics, comorbidities, and CHA 2 DS 2 ‐VASc score were recorded. LA scar was quantified during electroanatomic voltage mapping using the BioSense Webster Oct array catheter D1609. Results A total of 229 patients with AF were included;107 (46.7%) demonstrated significant atrial scar, while 122 (53.3%) did not have significant scar burden. Of these, 147 patients with complete biomarker data were included in the final analysis. Scar‐present patients had significantly higher NT‐proBNP, hsCRP, and BMI, along with a higher prevalence of dyslipidemia, obstructive sleep apnoea, and hypothyroidism, and a significantly different AF type distribution (all p < 0.05). On univariable logistic regression, significant predictors of atrial scar included NT‐proBNP, BMI, hypothyroidism, Longstanding persistent Atrial Fibrillation (AF LS‐persistent), dyslipidemia, obstructive sleep apnea, and CHA 2 DS 2 ‐VASc score, with hsCRP demonstrating a borderline association ( p = 0.076). On multivariable logistic regression, LS‐persistent AF was the only independent predictor of significant atrial scar ( p = 0.026), while BMI and hypothyroidism showed borderline independent associations ( p < 0.10). Conclusions Our findings suggest a possible correlation of inflammatory markers and Left Atrial scar burden. The association of other comorbidities, like higher BMI, hypothyroidism, dyslipidemia, and sleep apnea, with a higher atrial scar burden may be related to myocardial stress. This suggests an interplay of inflammatory markers and comorbidities, which result in a significant scar burden either directly or indirectly