Epidemiology
Higher Lp(a) percentile predicts rising risk of atrial fibrillation recurrence after pulsed field ablation, 133-patient Ferrara study finds (J Cardiovasc Med (Hagerstown) 2025)
Original title: Lipoprotein(a) and risk of recurrent atrial fibrillation after pulsed field ablation
This retrospective cohort study analysed 133 patients (mean age 59.6 years, 29.3% women) who underwent pulsed field ablation for atrial fibrillation (AF) at Ferrara University Hospital between October 2023 and January 2025, testing whether Lp(a) percentile predicts AF recurrence. Over a median 7.8-month follow-up after the blanking period, 29 patients (21.8%) had confirmed recurrent AF, and recurrence risk rose continuously with Lp(a) percentile: adjusted hazard ratios were 1.13 (95% CI 1.04-1.22, P < 0.001) for the 51st-70th percentile, 1.21 (95% CI 1.11-1.31, P < 0.001) for the 71st-90th, and 1.26 (95% CI 1.13-1.39, P < 0.001) for the 91st-100th, relative to the reference group below the 50th percentile. The authors suggest Lp(a)-lowering therapies might help reduce AF recurrence after this newer ablation technique, though the finding needs confirmation in larger cohorts.
Original abstract
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.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.