Lipoprotein(a) and risk of recurrent atrial fibrillation after pulsed field ablation

Aims Lipoprotein(a) [Lp(a)] is a recognized risk factor for atherosclerotic cardiovascular disease. However, its potential association with the risk of recurrent atrial fibrillation (AF) after ablation remains unexplored. This study aimed to investigate whether Lp(a) serum levels are linked to the risk of recurrent AF following pulsed field ablation (PFA). Methods A retrospective cohort analysis was conducted on patients who underwent PFA at the Cardiology Clinic of the Ferrara University Hospital from October 2023 to January 2025. Lp(a) percentile groups were established, with the first 50th percentile serving as the reference. Cox proportional hazards modeling was used to assess the relationship between Lp(a) percentile and recurrent AF after PFA. Results The study included 133 patients (mean age 59.6 years, 29.3% women). Over a median follow-up of 7.8 months after the blanking period (range: 6.4–9.3 months), 29 patients (21.8%) experienced confirmed recurrent AF. A continuous increase in the hazard of recurrent AF was observed with rising Lp(a) levels. Specifically, individuals in the 51st–70th, 71st–90th, and 91st–100th Lp(a) percentiles had adjusted hazard ratios of 1.13 [95% confidence interval (CI): 1.04–1.22, P < 0.001], 1.21 (95% CI: 1.11–1.31, P < 0.001), and 1.26 (95% CI: 1.13–1.39, P < 0.001), respectively. Conclusions Elevated Lp(a) levels are associated with an increased risk of recurrent AF after PFA, suggesting that Lp(a)-lowering therapies may be beneficial for these patients.