Retrospective Evaluation of the Relationship Between Catheter Ablation and Systemic Immune-Inflammation Index in Cardiac Arrhythmias

Retrospective Evaluation of the Relationship Between Catheter Ablation and Systemic Immune-Inflammation Index in Cardiac Arrhythmias | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Retrospective Evaluation of the Relationship Between Catheter Ablation and Systemic Immune-Inflammation Index in Cardiac Arrhythmias Ibrahim Etem DURAL, Halil Siner This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8276620/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 24 Apr, 2026 Read the published version in BMC Cardiovascular Disorders → Version 1 posted 11 You are reading this latest preprint version Abstract Background Catheter ablation induces controlled myocardial injury and transient endothelial dysfunction, both of which may trigger a systemic inflammatory response. The systemic immune-inflammation index (SII) has emerged as a sensitive biomarker reflecting the interplay between inflammation, thrombosis, and immune regulation; however, its peri-procedural behavior after ablation remains unclear. Objective To evaluate changes in SII following catheter ablation across different arrhythmia subtypes and to determine independent predictors of ΔSII. Methods In this retrospective cohort study, 642 adult patients who underwent catheter ablation between January 2022 and December 2024 were analyzed. Pre-procedural and 1-week post-procedural SII values were compared in diagnostic EPS, supraventricular tachycardia (SVT), atrial fibrillation (AF; RF and cryoablation), atrial tachycardia (AT), atrial flutter (AFL), and ventricular ectopy (VES) groups. Multivariable linear regression assessed predictors of ΔSII. Effect sizes were calculated using Cohen’s d and Hedges’ g. Results Overall SII increased significantly after ablation (p = 0.001). AF groups demonstrated the strongest effect sizes (RF-AF: d = 0.84; Cryo-AF: d = 1.07). No significant changes were observed after diagnostic EPS or AFL ablation. Regression analysis identified EF (β = − 19.4; p = 0.045), RF-AF (β = 808; p = 0.0016), Cryo-AF (β = 710; p < 0.001), and VES ablation (β = 471; p = 0.036) as independent predictors of ΔSII. The model demonstrated adequate power (post-hoc power = 0.805). Conclusion Catheter ablation—particularly AF and VES ablation—is associated with significant early SII elevation, independent of conventional inflammatory markers such as CRP. SII may serve as a more sensitive biomarker of subclinical endothelial and inflammatory perturbations following ablation. Catheter ablation systemic immune-inflammation index atrial fibrillation inflammation electrophysiology Figures Figure 1 Figure 2 Figure 3 HIGHLIGHTS SII rises significantly after catheter ablation, especially in AF patients. SII is more sensitive than CRP for detecting procedure-related inflammation. RF and cryoablation produce strong inflammatory responses with large effect sizes. ΔSII is independently predicted by EF and ablation subtype. SII may be a useful clinical biomarker for post-procedural risk assessment. INTRODUCTION Catheter ablation is an established therapeutic strategy for a wide spectrum of cardiac arrhythmias, offering high success rates and improved long-term outcomes. Despite its efficacy, ablation induces localized myocardial injury, microvascular trauma, oxidative stress, and varying degrees of endothelial dysfunction. These mechanisms collectively generate an inflammatory response, the magnitude of which may differ according to ablation type, energy modality, and arrhythmia substrate. The systemic immune-inflammation index (SII), incorporating neutrophil, lymphocyte, and platelet counts, has shown superior prognostic value in acute and chronic cardiovascular conditions, outperforming conventional markers such as CRP. While SII has been extensively evaluated in heart failure and coronary syndromes, its role as a biomarker of procedural inflammation after catheter ablation has not been systematically studied. Although several studies have examined CRP and troponin release after ablation, no contemporary large-scale study has investigated SII behavior across different arrhythmia subtypes and ablation modalities. We hypothesized that catheter ablation would lead to a significant increase in SII, and this increase would vary by arrhythmia subtype and procedural characteristics, independent of CRP. The present study aims to quantify peri-procedural changes in SII across multiple ablation types, determine the clinical relevance of these changes using effect size analysis, and identify independent predictors of ΔSII through multivariable modeling. METHODS Study Design and Population This retrospective, single-center observational study included adult patients (18–80 years) who underwent catheter ablation at our institution between January 2022 and December 2024. Demographic, clinical, laboratory, and procedural data were retrieved from institutional electronic medical records.(Flowchart) This study is not a clinical trial. It does not involve prospective patient enrollment, randomization, experimental intervention, or any clinical trial procedures. Instead, it is a retrospective, analysis-based study. Therefore, no clinical trial registration, registration number, or regulatory trial documentation is required. Inclusion Criteria Documented arrhythmia diagnosed via ECG or Holter monitoring Undergoing catheter ablation or diagnostic electrophysiological study (EPS) Availability of pre-procedural and 1-week post-procedural blood tests Exclusion Criteria Active infection Thyroid dysfunction Hepatic or renal failure Autoimmune or hematological disease Malignancy Pericarditis or myocarditis Chronic steroid or antipsychotic use Hemodialysis Biochemical analysis was conducted using pre- and 1 week post-ablation samples(Biyo CE Cobas 8000, Roche Diagnostics, Basel, Switzerland). Baseline ECGs were documented for all patients. SII was calculated as: SII = (Platelet × Neutrophil) / Lymphocyte Samples were obtained: 24 hours before ablation 7 days after ablation AF was diagnosed per 2024 ESC guidelines: absence of discernible P-waves with irregular RR intervals lasting ≥30 seconds on a 12-lead or single-lead ECG. RF vs. cryoablation choice depended on AF duration and operator preference. PVC ablation was performed in patients with >20% PVC burden on Holter monitoring or >10% with symptoms. Three-dimensional electroanatomical mapping was performed using the CARTO system (Biosense Webster). Irrigated ablation catheters (Thermocool Smarttouch™, Biosense Webster) were used. Ablation was targeted to areas with abnormal electrical activity identified during mapping. For cryoablation, Arctic Front Cryoballoon (Medtronic CryoCath) catheters were used under fluoroscopic guidance. In SVT ablations, energy was delivered at 60°C, 50 W for 45 seconds at the identified target site. For RF ablation in AF patients, pulmonary veins were mapped in 3D and ablated using a point-by-point approach at 50°C, 45 W for 15 seconds. In cryoablation, pulmonary veins were localized under fluoroscopy and cryoenergy was applied targeting –40°C. For PVC ablation, following 3D mapping, ablation was performed at 60°C and 40 W at the arrhythmic substrate region. Ethics Approval: This study was approved by the Non-Interventional Clinical Research Ethics Committee (Approval No: 2025/8, Date: 13/06/2025). All procedures were performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Statistical Analysis: Analyses were performed using SPSS version 27. Normality was evaluated using the Kolmogorov–Smirnov test, Q–Q plots, and skewness–kurtosis indices. For paired measurements, either the paired t-test or the Wilcoxon signed-rank test was used, depending on distributional properties. Between-group comparisons were conducted using ANOVA or the Kruskal–Wallis test. Categorical variables were analyzed with the Chi-square test. Effect sizes were calculated using Cohen’s d and Hedges’ g with corresponding 95% confidence intervals. Multivariable linear regression analysis was performed to identify independent predictors of ΔSII. Multicollinearity was assessed using the variance inflation factor (VIF), with a threshold of <5 considered acceptable. A two-sided p value <0.05 was regarded as statistically significant. Results Median patient age: 53 years (mean: 51.38 ± 15.1). RF-AF (63 ± 10.6) and cryoablation (60.35 ± 8.4) groups were older; AVRT group had lowest mean age (37.36 ± 16). Male: 47.3%, female: 52.7%. Atrial flutter patients had highest male prevalence (87.75%), atrial tachycardia patients had highest female prevalence (86.7%). Arrhythmia was non-inducible in 17.9% during EPS. Arrhythmia types: AVNRT (40.92%), AVRT (8.9%), AF (12.4%), atrial tachycardia (5.8%), atrial flutter (3.1%), PVC (10.1%).(Table 1 ) Table 1 Basic Characteristics of the Patients Included in the Study n:642 Variable Value Age 51.35 ± 15.1 Gender (Male) n= 47.3% Hypertension 38.4% Diabetes Mellitus 20.9% Dyslipidemia 17.3% Coronary Artery Disease 18.4% Previous PCI or CABG 9.9% Creatinine 0.89 ± 0.49 CRP 4.16 ± 5.2 AVNRT 40.9% AVRT 8.9% AF (RF + Cryoablation) 12.4% Atrial Tachycardia 5.8% Atrial Flutter 3.1% Ventricular Extrasystole (PVC) 10.1% Most common comorbidity: hypertension (HT), highest in RF group (64.3%), lowest in AVRT (13.1%). DM was next most common, peaking in RF group (35.7%), followed by PVC (34.6%) and lowest in AVRT (4.3%). Atrial flutter had highest recurrence (28.57%), AVNRT the lowest (2.27%). Four patients (all RF) developed pericardial effusion, managed conservatively. Bleeding complications occurred in 32 patients, managed with prolonged compression; no transfusion required. Pseudoaneurysms detected in 18 patients (2.8%) were treated with tissue adhesive (n = 16) or surgery (n = 2). No surgical complications; all discharged by day 5. Phrenic nerve injury in 2 patients resolved with respiratory exercises.(Table 2 ) Table 2 Major Complications Complication Total (n = 642) Normal (n = 93) SVT (n = 384) AF (n = 93) PVC (n = 72) Bleeding 32 2 20 8 2 Retroperitoneal Hemorrhage 1 0 0 0 1 Pseudoaneurysm 18 2 10 5 1 Pericardial Effusion 4 0 0 4 0 Phrenic Nerve Injury 2 0 0 2 0 There was no significant difference in preoperative and postoperative SII values in the subgroups of patients who underwent diagnostic EPS (without ablation) and underwent atrial flutter ablation in the patients included in the study, while a significant difference was detected in other subgroups and is shown in Table 3 . Table 3 SII change in cardiac catheterization by type of procedure Variable Preop-SII(Mean + SD) Postop-SII(Mean + SD) 95%CI(Lower-Upper) p-value Diagnostic 700.33 ± 582 596.77 ± 231 -382.77-175.6 0.445 AVNRT 621.07 ± 367 732.51 ± 516 1.51-221.34 0.047 AVRT 550.43 ± 208 911.76 ± 531 107.75-614.95 0.008 RF-AF 1037.50 ± 1239 1777.44 ± 1365 232.02-1247.86 0.008 CRYO-AF 538.95 ± 337 1151.23 ± 705 394.31-830.25 0.001 AT 557.38 ± 262 706.38 ± 283 9.63-288.37 0.038 A.FLUTTER 996.00 ± 635 1449.98 ± 1150 -328.43-1236.39 0.205 PVC 438.62 ± 168 725.75 ± 523 102.13-472.13 0.004 When the effect size is evaluated according to the arrhythmia subgroup, it is seen that the preoperative and postoperative SII values ​​of the RF-AF and CRYO-AF groups are statistically significant and also have a strong clinical effect. (RF-AF:Cohen’s d = 0.84; 95% CI: 0.21–1.44; Hedges’ g = 0.81; 95% CI: 0.20–1.40, CRYO-AF:Cohen’s d = 1.09; 95% CI: 0.61–1.55; Hedges’ g = 1.07; 95% CI: 0.60–1.53)(Table 4 ) Table 4 Effect sizes of preoperative and postoperative comparisons according to arrhythmia subtype Variables Measure Point Estimate 95% CI Lower 95% CI Upper Interpretation Diagnostic Cohen's d -0.184 -0.648 0.284 Negligible Hedges' correction -0.180 -0.633 0.278 Negligible AVNRT Cohen's d 0.215 0.003 0.426 + Hedges' correction 0.214 0.003 0.424 + AVRT Cohen's d 0.649 0.170 1.114 ++ Hedges' correction 0.636 0.167 1.093 ++ RF-AF Cohen's d 0.841 0.216 1.443 +++ Hedges' correction 0.817 0.209 1.401 +++ CRYO-AF Cohen's d 1.089 0.613 1.553 +++ Hedges' correction 1.074 0.604 1.531 +++ AT Cohen's d 0.679 0.036 1.299 ++ Hedges' correction 0.656 0.034 1.254 ++ A.FLUTTER Cohen's d 0.537 -0.280 1.316 Negligible Hedges' correction 0.502 -0.262 1.232 Negligible PVC Cohen's d 0.655 0.207 1.092 ++ Hedges' correction 0.645 0.204 1.074 ++ A multivariable linear regression model was used to identify factors associated with the change in systemic inflammatory index (ΔSII). The model included three continuous predictors (CRP, age, and left ventricular ejection fraction [EF]) and one categorical predictor representing the type of ablation procedure. In total, 10 predictors were analyzed in the final regression model(Table 5 ). Table 5 :Multivariable Linear Regression Variable Beta Std Error t P value 95% CI Lower 95% CI Upper Std Beta CRP -5.03 9.49 -0.530 0.597 -23.8 13.8 -0.0442 Age -5.03 3.99 -1.26 0.210 -12.9 2.87 -0.110 EF -19.4 9.62 -2.02 0.0457 -38.5 -0.377 -0.184 AVNRT 178 176 1.01 0.314 -171 528 0.132 AVRT 251 254 0.988 0.325 -252 753 0.0968 RF-AF 808 251 3.22 0.00165 311 1304 0.342 Cryo-AF 710 202 3.52 0.000601 311 1109 0.413 AT 107 291 0.366 0.715 -470 684 0.0340 A.FLUTTER 151 321 0.471 0.639 -484 787 0.0442 PVC 471 222 2.12 0.0358 31.8 910 0.236 A post-hoc power analysis was performed for the multivariable linear regression model. Since a total of ten independent predictors were included in the model, the error degrees of freedom were calculated as v = 631. The effect size of the regression model was evaluated using Cohen’s f² statistic, which was found to be f² = 0.062, indicating a small-to-medium effect size. At the 5% significance level, the statistical power of the model was calculated as power = 0.805, demonstrating that the available sample size was adequate for the multivariable regression analysis. DISCUSSION In this study, we investigated the effects of catheter ablation on systemic inflammatory markers, with a particular focus on the systemic immune-inflammation index (SII), across different ablation locations and arrhythmia types.(Fig. 1 -Figure 2) Our results demonstrate that catheter ablation—particularly in patients undergoing atrial fibrillation (AF) and ventricular ectopic beat (PVC) ablation—causes a marked early increase in SII. This elevation was statistically significant and clinically relevant. The more pronounced inflammatory response observed in AF ablation groups likely reflects the substantially larger lesion burden created during circumferential pulmonary vein isolation, which involves wider myocardial surface areas and prolonged energy delivery. This extensive ablation field induces greater endothelial disruption and oxidative stress, thereby amplifying systemic inflammatory activation compared with more focal SVT or PVC ablation procedures. In contrast, patients undergoing diagnostic electrophysiological study (EPS) or atrial flutter ablation did not show a significant increase. These findings highlight that the systemic inflammatory response varies depending on both arrhythmia substrate and ablation modality. An important observation in our study is that postoperative CRP levels did not change significantly, while SII increased substantially. This dissociation indicates that SII may be a more sensitive marker of subclinical inflammation and endothelial dysfunction than traditional inflammatory biomarkers. Previous studies have similarly emphasized that endothelial injury and subtle inflammatory responses may not always be reflected by conventional markers such as CRP ( 1 , 2 ). Our findings support this view, suggesting that SII may better detect inflammatory and immune disturbances following ablation. Catheter ablation has become one of the most effective therapeutic options for cardiac arrhythmias, supported by advanced intracardiac imaging and three-dimensional mapping technologies. With these developments, arrhythmogenic substrates of AF, atrial flutter, and ventricular tachycardia can be accurately identified and ablated, yielding high success rates and improved long-term outcomes ( 3 ). Ablation therapy has contributed to reduced arrhythmia-related morbidity and sudden cardiac death while improving quality of life ( 4 ). Furthermore, early ablation of arrhythmias may prevent cardiac structural deterioration, thereby reducing the risk of right or left heart failure ( 3 , 5 , 6 ). Despite its benefits, catheter ablation carries procedural risks. Various complications may arise, including vascular injury, cardiac perforation, thromboembolism, coronary artery damage due to anatomical proximity, iatrogenic arrhythmias, phrenic nerve injury, and atrio-esophageal fistula ( 7 , 8 ). In our study, the most common complications were local vascular complications, consistent with the literature. Although hypertension and higher CHADSVASc scores have been identified as predictors of complications in previous studies ( 9 , 10 ), hypertension did not reach statistical significance in our cohort (p = 0.079). The systemic immune-inflammation index (SII) integrates neutrophil, platelet, and lymphocyte counts to reflect both inflammatory activation and immune competence. Neutrophils contribute to inflammation and oxidative injury, platelets support thrombosis and amplify inflammatory signaling, and lymphocytes represent adaptive immune defense. For this reason, increased SII indicates a proinflammatory state along with compromised immune regulation. Initially proposed as a prognostic biomarker in oncology, SII has since been adopted across various fields, including cardiovascular medicine, autoimmune diseases, infectious conditions, and perioperative care. In cardiovascular research, elevated SII has been associated with atherosclerotic burden, myocardial injury, arrhythmogenesis, and unfavorable postoperative outcomes ( 11 – 13 ). Catheter ablation induces not only localized tissue destruction but also systemic biological responses. The use of radiofrequency or cryoenergy leads to oxidative stress, cytokine release, microvascular injury, and inflammatory activation ( 14 ). This inflammation may influence procedural outcomes, including arrhythmia recurrence ( 15 ). Inflammatory damage to cardiac tissue has been implicated in AF recurrence after ablation, highlighting the importance of understanding the inflammatory response to energy delivery. Importantly, recent studies have shown that catheter ablation may alter inflammatory, oxidative, and immune responses in both the short and long term ( 14 – 17 ). Endothelial dysfunction is another systemic consequence of ablation. Microvascular and endothelial injury during the procedure may affect vascular function and increase the risk of thrombosis, atherosclerosis, and adverse cardiovascular outcomes ( 16 , 17 ). As endothelial dysfunction is closely linked to inflammation, monitoring biomarkers such as SII may help identify patients prone to vascular complications after ablation. Recent evidence suggests that elevated SII levels are associated with worse outcomes in heart failure (HF), including faster progression and poorer prognosis ( 18 , 19 ). Although AF ablation has been shown to reduce the long-term risk of HF by facilitating stable rhythm control ( 20 – 22 ), the early inflammatory response following ablation may transiently worsen cardiac function ( 14 , 23 , 24 , 25 ). In our study, SII values significantly increased early after ablation. Moreover, patients with lower left ventricular ejection fraction (EF) exhibited a greater inflammatory response, suggesting that impaired ventricular function may predispose individuals to heightened inflammation and tissue vulnerability. Understanding the systemic inflammatory consequences of catheter ablation is crucial for optimizing peri-procedural management. Future research should explore strategies to mitigate inflammation and oxidative stress following ablation. Additionally, the influence of energy amount, lesion characteristics, and application duration on systemic inflammatory response warrants further investigation. Such insights may contribute to safer ablation protocols and improved long-term patient outcomes. Limitations The retrospective design limits control over potential confounding variables. Additionally, the single-center nature of the cohort may reduce the generalizability of the findings. Procedural parameters such as lesion number and radiofrequency application duration were not fully quantified, which may influence the inflammatory response. Moreover, SII was measured only one week after the procedure, providing no information about long-term trends or persistent inflammation. Finally, the potential effects of concomitant medications, particularly anticoagulants and statins, were not evaluated and may have impacted the observed results. CONCLUSION Catheter ablation significantly increases SII in a procedure- and substrate-dependent manner, with the strongest response observed in AF ablation. SII provides a more sensitive measure of post-ablation inflammation than CRP and may have important clinical implications for risk stratification and follow-up. Declarations Conflict of Interest Statement: The authors declare that there are no conflicts of interest related to this manuscript. Artificial Intelligence Use Disclosure: No generative artificial intelligence or AI-assisted tools were used in the preparation of this manuscript. All content was created and reviewed entirely by the authors Data Availability Statement: The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Consent to Participate All authors confirm that ethical approval for this study was obtained from the appropriate institutional ethics committee, and informed consent was collected from all participants (or their legal guardians, when applicable) prior to inclusion in the study. All participants voluntarily agreed to take part in the research, and the procedures were conducted in accordance with the Declaration of Helsinki. The authors declare that all participants provided full consent to participate. Consent for Publication All authors confirm that they have obtained consent for publication from all participants whose data, images, or clinical information are included in the manuscript. No identifiable personal information is presented. All authors approve the publication of this manuscript and consent to its submission. 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Cite Share Download PDF Status: Published Journal Publication published 24 Apr, 2026 Read the published version in BMC Cardiovascular Disorders → Version 1 posted Editorial decision: Revision requested 05 Mar, 2026 Reviews received at journal 23 Feb, 2026 Reviews received at journal 13 Jan, 2026 Reviewers agreed at journal 12 Jan, 2026 Reviewers agreed at journal 06 Jan, 2026 Reviewers agreed at journal 06 Jan, 2026 Reviewers invited by journal 06 Jan, 2026 Editor invited by journal 16 Dec, 2025 Editor assigned by journal 14 Dec, 2025 Submission checks completed at journal 14 Dec, 2025 First submitted to journal 04 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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08:07:58","extension":"xml","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":126710,"visible":true,"origin":"","legend":"","description":"","filename":"935e319aad674006a7a922110e4d35a01structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8276620/v1/498533e12c1ac9f32a302720.xml"},{"id":100362360,"identity":"e55975af-b8b1-497b-9a53-c60f20d152ac","added_by":"auto","created_at":"2026-01-16 07:46:36","extension":"html","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":138105,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8276620/v1/f58ea07adf78a671f7516e28.html"},{"id":100021956,"identity":"db6def1c-c769-4c32-96a2-986664bcb77f","added_by":"auto","created_at":"2026-01-12 08:07:58","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":14062,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSII change in diagnostic and interventional cardiac catheterization\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8276620/v1/b75f73daf263089ab530faa2.png"},{"id":100362521,"identity":"c9fedb5c-8499-45b2-bf78-999d922fd12f","added_by":"auto","created_at":"2026-01-16 07:46:55","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":20819,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSII change in cardiac catheterization by type of procedure\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8276620/v1/484e0aba11e312e14dafa995.png"},{"id":100021959,"identity":"3a6ffb01-1c50-4a1a-b064-4919047e8dba","added_by":"auto","created_at":"2026-01-12 08:07:58","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":65785,"visible":true,"origin":"","legend":"\u003cp\u003eUnnumbered image in the methods section.\u003c/p\u003e","description":"","filename":"Unnumberfig.png","url":"https://assets-eu.researchsquare.com/files/rs-8276620/v1/20a6e5d8ef6b6372e7769a33.png"},{"id":107927891,"identity":"d0a1ee42-e3aa-4651-8aaf-7c02a982255b","added_by":"auto","created_at":"2026-04-27 16:05:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":472423,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8276620/v1/464bb7b9-c37b-4bcb-b21b-9da1e58d6cfa.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Retrospective Evaluation of the Relationship Between Catheter Ablation and Systemic Immune-Inflammation Index in Cardiac Arrhythmias","fulltext":[{"header":"HIGHLIGHTS","content":"\u003cul type=\"disc\"\u003e\n \u003cli\u003eSII rises significantly after catheter ablation, especially in AF patients.\u003c/li\u003e\n \u003cli\u003eSII is more sensitive than CRP for detecting procedure-related inflammation.\u003c/li\u003e\n \u003cli\u003eRF and cryoablation produce strong inflammatory responses with large effect sizes.\u003c/li\u003e\n \u003cli\u003eΔSII is independently predicted by EF and ablation subtype.\u003c/li\u003e\n \u003cli\u003eSII may be a useful clinical biomarker for post-procedural risk assessment.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"INTRODUCTION","content":"\u003cp\u003eCatheter ablation is an established therapeutic strategy for a wide spectrum of cardiac arrhythmias, offering high success rates and improved long-term outcomes. Despite its efficacy, ablation induces localized myocardial injury, microvascular trauma, oxidative stress, and varying degrees of endothelial dysfunction. These mechanisms collectively generate an inflammatory response, the magnitude of which may differ according to ablation type, energy modality, and arrhythmia substrate.\u003c/p\u003e \u003cp\u003eThe systemic immune-inflammation index (SII), incorporating neutrophil, lymphocyte, and platelet counts, has shown superior prognostic value in acute and chronic cardiovascular conditions, outperforming conventional markers such as CRP. While SII has been extensively evaluated in heart failure and coronary syndromes, its role as a biomarker of procedural inflammation after catheter ablation has not been systematically studied.\u003c/p\u003e \u003cp\u003eAlthough several studies have examined CRP and troponin release after ablation, no contemporary large-scale study has investigated SII behavior across different arrhythmia subtypes and ablation modalities.\u003c/p\u003e \u003cp\u003eWe hypothesized that catheter ablation would lead to a significant increase in SII, and this increase would vary by arrhythmia subtype and procedural characteristics, independent of CRP.\u003c/p\u003e \u003cp\u003eThe present study aims to quantify peri-procedural changes in SII across multiple ablation types, determine the clinical relevance of these changes using effect size analysis, and identify independent predictors of ΔSII through multivariable modeling.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e\u003cstrong\u003eStudy Design and Population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective, single-center observational study included adult patients (18\u0026ndash;80 years) who underwent catheter ablation at our institution between January 2022 and December 2024. Demographic, clinical, laboratory, and procedural data were retrieved from institutional electronic medical records.(Flowchart)\u003c/p\u003e\n\u003cp\u003eThis study is not a clinical trial. It does not involve prospective patient enrollment, randomization, experimental intervention, or any clinical trial procedures. Instead, it is a retrospective, analysis-based study. Therefore, no clinical trial registration, registration number, or regulatory trial documentation is required.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eDocumented arrhythmia diagnosed via ECG or Holter monitoring\u003c/li\u003e\n \u003cli\u003eUndergoing catheter ablation or diagnostic electrophysiological study (EPS)\u003c/li\u003e\n \u003cli\u003eAvailability of pre-procedural and 1-week post-procedural blood tests\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eActive infection\u003c/li\u003e\n \u003cli\u003eThyroid dysfunction\u003c/li\u003e\n \u003cli\u003eHepatic or renal failure\u003c/li\u003e\n \u003cli\u003eAutoimmune or hematological disease\u003c/li\u003e\n \u003cli\u003eMalignancy\u003c/li\u003e\n \u003cli\u003ePericarditis or myocarditis\u003c/li\u003e\n \u003cli\u003eChronic steroid or antipsychotic use\u003c/li\u003e\n \u003cli\u003eHemodialysis\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eBiochemical analysis was conducted using pre- and 1 week post-ablation samples(Biyo CE Cobas 8000, Roche Diagnostics, Basel, Switzerland). Baseline ECGs were documented for all patients.\u003c/p\u003e\n\u003cp\u003eSII was calculated as:\u003cbr\u003e\u0026nbsp;SII = (Platelet \u0026times; Neutrophil) / Lymphocyte\u003c/p\u003e\n\u003cp\u003eSamples were obtained:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e24 hours before ablation\u003c/li\u003e\n \u003cli\u003e7 days after ablation\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAF was diagnosed per 2024 ESC guidelines: absence of discernible P-waves with irregular RR intervals lasting \u0026ge;30 seconds on a 12-lead or single-lead ECG. RF vs. cryoablation choice depended on AF duration and operator preference.\u003c/p\u003e\n\u003cp\u003ePVC ablation was performed in patients with \u0026gt;20% PVC burden on Holter monitoring or \u0026gt;10% with symptoms.\u003c/p\u003e\n\u003cp\u003eThree-dimensional electroanatomical mapping was performed using the CARTO system (Biosense Webster). Irrigated ablation catheters (Thermocool Smarttouch\u0026trade;, Biosense Webster) were used. Ablation was targeted to areas with abnormal electrical activity identified during mapping.\u003c/p\u003e\n\u003cp\u003eFor cryoablation, Arctic Front Cryoballoon (Medtronic CryoCath) catheters were used under fluoroscopic guidance.\u003c/p\u003e\n\u003cp\u003eIn SVT ablations, energy was delivered at 60\u0026deg;C, 50 W for 45 seconds at the identified target site. For RF ablation in AF patients, pulmonary veins were mapped in 3D and ablated using a point-by-point approach at 50\u0026deg;C, 45 W for 15 seconds. In cryoablation, pulmonary veins were localized under fluoroscopy and cryoenergy was applied targeting \u0026ndash;40\u0026deg;C. For PVC ablation, following 3D mapping, ablation was performed at 60\u0026deg;C and 40 W at the arrhythmic substrate region.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval:\u003c/strong\u003e This study was approved by the Non-Interventional Clinical Research Ethics Committee (Approval No: 2025/8, Date: 13/06/2025). All procedures were performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAnalyses were performed using SPSS version 27. Normality was evaluated using the Kolmogorov\u0026ndash;Smirnov test, Q\u0026ndash;Q plots, and skewness\u0026ndash;kurtosis indices. For paired measurements, either the paired t-test or the Wilcoxon signed-rank test was used, depending on distributional properties. Between-group comparisons were conducted using ANOVA or the Kruskal\u0026ndash;Wallis test. Categorical variables were analyzed with the Chi-square test. Effect sizes were calculated using Cohen\u0026rsquo;s d and Hedges\u0026rsquo; g with corresponding 95% confidence intervals. Multivariable linear regression analysis was performed to identify independent predictors of \u0026Delta;SII. Multicollinearity was assessed using the variance inflation factor (VIF), with a threshold of \u0026lt;5 considered acceptable. A two-sided p value \u0026lt;0.05 was regarded as statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eMedian patient age: 53 years (mean: 51.38\u0026thinsp;\u0026plusmn;\u0026thinsp;15.1). RF-AF (63\u0026thinsp;\u0026plusmn;\u0026thinsp;10.6) and cryoablation (60.35\u0026thinsp;\u0026plusmn;\u0026thinsp;8.4) groups were older; AVRT group had lowest mean age (37.36\u0026thinsp;\u0026plusmn;\u0026thinsp;16). Male: 47.3%, female: 52.7%. Atrial flutter patients had highest male prevalence (87.75%), atrial tachycardia patients had highest female prevalence (86.7%).\u003c/p\u003e \u003cp\u003eArrhythmia was non-inducible in 17.9% during EPS. Arrhythmia types: AVNRT (40.92%), AVRT (8.9%), AF (12.4%), atrial tachycardia (5.8%), atrial flutter (3.1%), PVC (10.1%).(Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBasic Characteristics of the Patients Included in the Study n:642\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eValue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51.35\u0026thinsp;\u0026plusmn;\u0026thinsp;15.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender (Male) n=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes Mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyslipidemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoronary Artery Disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevious PCI or CABG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCreatinine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.16\u0026thinsp;\u0026plusmn;\u0026thinsp;5.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAVNRT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAVRT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAF (RF\u0026thinsp;+\u0026thinsp;Cryoablation)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAtrial Tachycardia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAtrial Flutter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVentricular Extrasystole (PVC)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eMost common comorbidity: hypertension (HT), highest in RF group (64.3%), lowest in AVRT (13.1%). DM was next most common, peaking in RF group (35.7%), followed by PVC (34.6%) and lowest in AVRT (4.3%).\u003c/p\u003e \u003cp\u003eAtrial flutter had highest recurrence (28.57%), AVNRT the lowest (2.27%). Four patients (all RF) developed pericardial effusion, managed conservatively.\u003c/p\u003e \u003cp\u003eBleeding complications occurred in 32 patients, managed with prolonged compression; no transfusion required. Pseudoaneurysms detected in 18 patients (2.8%) were treated with tissue adhesive (n\u0026thinsp;=\u0026thinsp;16) or surgery (n\u0026thinsp;=\u0026thinsp;2). No surgical complications; all discharged by day 5. Phrenic nerve injury in 2 patients resolved with respiratory exercises.(Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMajor Complications\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplication\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;642)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNormal (n\u0026thinsp;=\u0026thinsp;93)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSVT\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;384)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAF\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;93)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePVC\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;72)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBleeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRetroperitoneal Hemorrhage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePseudoaneurysm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePericardial Effusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhrenic Nerve Injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThere was no significant difference in preoperative and postoperative SII values in the subgroups of patients who underwent diagnostic EPS (without ablation) and underwent atrial flutter ablation in the patients included in the study, while a significant difference was detected in other subgroups and is shown in Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSII change in cardiac catheterization by type of procedure\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026minus;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePreop-SII(Mean\u0026thinsp;+\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePostop-SII(Mean\u0026thinsp;+\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95%CI(Lower-Upper)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiagnostic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e700.33\u0026thinsp;\u0026plusmn;\u0026thinsp;582\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e596.77\u0026thinsp;\u0026plusmn;\u0026thinsp;231\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c4\"\u003e \u003cp\u003e-382.77-175.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.445\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAVNRT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e621.07\u0026thinsp;\u0026plusmn;\u0026thinsp;367\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e732.51\u0026thinsp;\u0026plusmn;\u0026thinsp;516\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c4\"\u003e \u003cp\u003e1.51-221.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.047\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAVRT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e550.43\u0026thinsp;\u0026plusmn;\u0026thinsp;208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e911.76\u0026thinsp;\u0026plusmn;\u0026thinsp;531\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c4\"\u003e \u003cp\u003e107.75-614.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.008\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRF-AF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1037.50\u0026thinsp;\u0026plusmn;\u0026thinsp;1239\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1777.44\u0026thinsp;\u0026plusmn;\u0026thinsp;1365\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c4\"\u003e \u003cp\u003e232.02-1247.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.008\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRYO-AF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e538.95\u0026thinsp;\u0026plusmn;\u0026thinsp;337\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1151.23\u0026thinsp;\u0026plusmn;\u0026thinsp;705\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c4\"\u003e \u003cp\u003e394.31-830.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e557.38\u0026thinsp;\u0026plusmn;\u0026thinsp;262\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e706.38\u0026thinsp;\u0026plusmn;\u0026thinsp;283\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c4\"\u003e \u003cp\u003e9.63-288.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.038\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA.FLUTTER\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e996.00\u0026thinsp;\u0026plusmn;\u0026thinsp;635\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1449.98\u0026thinsp;\u0026plusmn;\u0026thinsp;1150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c4\"\u003e \u003cp\u003e-328.43-1236.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.205\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePVC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e438.62\u0026thinsp;\u0026plusmn;\u0026thinsp;168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e725.75\u0026thinsp;\u0026plusmn;\u0026thinsp;523\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c4\"\u003e \u003cp\u003e102.13-472.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWhen the effect size is evaluated according to the arrhythmia subgroup, it is seen that the preoperative and postoperative SII values ​​of the RF-AF and CRYO-AF groups are statistically significant and also have a strong clinical effect. (RF-AF:Cohen\u0026rsquo;s d\u0026thinsp;=\u0026thinsp;0.84; 95% CI: 0.21\u0026ndash;1.44; Hedges\u0026rsquo; g\u0026thinsp;=\u0026thinsp;0.81; 95% CI: 0.20\u0026ndash;1.40, CRYO-AF:Cohen\u0026rsquo;s d\u0026thinsp;=\u0026thinsp;1.09; 95% CI: 0.61\u0026ndash;1.55; Hedges\u0026rsquo; g\u0026thinsp;=\u0026thinsp;1.07; 95% CI: 0.60\u0026ndash;1.53)(Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEffect sizes of preoperative and postoperative comparisons according to arrhythmia subtype\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMeasure\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePoint Estimate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95% CI Lower\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e95% CI Upper\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eInterpretation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiagnostic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCohen's d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.648\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.284\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNegligible\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHedges' correction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.633\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.278\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNegligible\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAVNRT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCohen's d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.215\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.426\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHedges' correction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.424\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAVRT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCohen's d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.649\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e++\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHedges' correction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.636\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.093\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e++\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRF-AF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCohen's d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.841\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.216\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.443\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e+++\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHedges' correction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.817\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.209\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.401\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e+++\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRYO-AF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCohen's d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.089\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.613\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.553\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e+++\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHedges' correction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.074\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.604\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.531\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e+++\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCohen's d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.679\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.299\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e++\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHedges' correction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.656\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.034\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.254\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e++\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA.FLUTTER\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCohen's d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.537\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.280\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.316\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNegligible\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHedges' correction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.502\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.262\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.232\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNegligible\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePVC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCohen's d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.655\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.207\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.092\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e++\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHedges' correction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.645\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.074\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e++\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eA multivariable linear regression model was used to identify factors associated with the change in systemic inflammatory index (ΔSII). The model included three continuous predictors (CRP, age, and left ventricular ejection fraction [EF]) and one categorical predictor representing the type of ablation procedure. In total, 10 predictors were analyzed in the final regression model(Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e:Multivariable Linear Regression\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBeta\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStd Error\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95% CI Lower\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e95% CI Upper\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eStd Beta\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-5.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.530\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.597\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-23.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e13.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e-0.0442\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-5.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-1.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.210\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-12.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e-0.110\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-19.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-2.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.0457\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-38.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.377\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e-0.184\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAVNRT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e178\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e176\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.314\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e528\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.132\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAVRT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e251\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e254\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.988\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-252\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e753\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.0968\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRF-AF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e808\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e251\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.00165\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e311\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1304\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.342\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCryo-AF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e710\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000601\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e311\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.413\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e291\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.366\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.715\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-470\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e684\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.0340\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA.FLUTTER\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.471\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.639\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-484\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e787\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.0442\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePVC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e471\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e222\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.0358\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e31.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e910\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.236\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eA post-hoc power analysis was performed for the multivariable linear regression model. Since a total of ten independent predictors were included in the model, the error degrees of freedom were calculated as v\u0026thinsp;=\u0026thinsp;631. The effect size of the regression model was evaluated using Cohen\u0026rsquo;s f\u0026sup2; statistic, which was found to be f\u0026sup2; = 0.062, indicating a small-to-medium effect size. At the 5% significance level, the statistical power of the model was calculated as power\u0026thinsp;=\u0026thinsp;0.805, demonstrating that the available sample size was adequate for the multivariable regression analysis.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn this study, we investigated the effects of catheter ablation on systemic inflammatory markers, with a particular focus on the systemic immune-inflammation index (SII), across different ablation locations and arrhythmia types.(Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e-Figure 2) Our results demonstrate that catheter ablation\u0026mdash;particularly in patients undergoing atrial fibrillation (AF) and ventricular ectopic beat (PVC) ablation\u0026mdash;causes a marked early increase in SII. This elevation was statistically significant and clinically relevant. The more pronounced inflammatory response observed in AF ablation groups likely reflects the substantially larger lesion burden created during circumferential pulmonary vein isolation, which involves wider myocardial surface areas and prolonged energy delivery. This extensive ablation field induces greater endothelial disruption and oxidative stress, thereby amplifying systemic inflammatory activation compared with more focal SVT or PVC ablation procedures. In contrast, patients undergoing diagnostic electrophysiological study (EPS) or atrial flutter ablation did not show a significant increase. These findings highlight that the systemic inflammatory response varies depending on both arrhythmia substrate and ablation modality.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAn important observation in our study is that postoperative CRP levels did not change significantly, while SII increased substantially. This dissociation indicates that SII may be a more sensitive marker of subclinical inflammation and endothelial dysfunction than traditional inflammatory biomarkers. Previous studies have similarly emphasized that endothelial injury and subtle inflammatory responses may not always be reflected by conventional markers such as CRP (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Our findings support this view, suggesting that SII may better detect inflammatory and immune disturbances following ablation.\u003c/p\u003e \u003cp\u003eCatheter ablation has become one of the most effective therapeutic options for cardiac arrhythmias, supported by advanced intracardiac imaging and three-dimensional mapping technologies. With these developments, arrhythmogenic substrates of AF, atrial flutter, and ventricular tachycardia can be accurately identified and ablated, yielding high success rates and improved long-term outcomes (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Ablation therapy has contributed to reduced arrhythmia-related morbidity and sudden cardiac death while improving quality of life (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Furthermore, early ablation of arrhythmias may prevent cardiac structural deterioration, thereby reducing the risk of right or left heart failure (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite its benefits, catheter ablation carries procedural risks. Various complications may arise, including vascular injury, cardiac perforation, thromboembolism, coronary artery damage due to anatomical proximity, iatrogenic arrhythmias, phrenic nerve injury, and atrio-esophageal fistula (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). In our study, the most common complications were local vascular complications, consistent with the literature. Although hypertension and higher CHADSVASc scores have been identified as predictors of complications in previous studies (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), hypertension did not reach statistical significance in our cohort (p\u0026thinsp;=\u0026thinsp;0.079).\u003c/p\u003e \u003cp\u003eThe systemic immune-inflammation index (SII) integrates neutrophil, platelet, and lymphocyte counts to reflect both inflammatory activation and immune competence. Neutrophils contribute to inflammation and oxidative injury, platelets support thrombosis and amplify inflammatory signaling, and lymphocytes represent adaptive immune defense. For this reason, increased SII indicates a proinflammatory state along with compromised immune regulation. Initially proposed as a prognostic biomarker in oncology, SII has since been adopted across various fields, including cardiovascular medicine, autoimmune diseases, infectious conditions, and perioperative care. In cardiovascular research, elevated SII has been associated with atherosclerotic burden, myocardial injury, arrhythmogenesis, and unfavorable postoperative outcomes (\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCatheter ablation induces not only localized tissue destruction but also systemic biological responses. The use of radiofrequency or cryoenergy leads to oxidative stress, cytokine release, microvascular injury, and inflammatory activation (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). This inflammation may influence procedural outcomes, including arrhythmia recurrence (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Inflammatory damage to cardiac tissue has been implicated in AF recurrence after ablation, highlighting the importance of understanding the inflammatory response to energy delivery. Importantly, recent studies have shown that catheter ablation may alter inflammatory, oxidative, and immune responses in both the short and long term (\u003cspan additionalcitationids=\"CR15 CR16\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEndothelial dysfunction is another systemic consequence of ablation. Microvascular and endothelial injury during the procedure may affect vascular function and increase the risk of thrombosis, atherosclerosis, and adverse cardiovascular outcomes (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). As endothelial dysfunction is closely linked to inflammation, monitoring biomarkers such as SII may help identify patients prone to vascular complications after ablation.\u003c/p\u003e \u003cp\u003eRecent evidence suggests that elevated SII levels are associated with worse outcomes in heart failure (HF), including faster progression and poorer prognosis (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Although AF ablation has been shown to reduce the long-term risk of HF by facilitating stable rhythm control (\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), the early inflammatory response following ablation may transiently worsen cardiac function (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). In our study, SII values significantly increased early after ablation. Moreover, patients with lower left ventricular ejection fraction (EF) exhibited a greater inflammatory response, suggesting that impaired ventricular function may predispose individuals to heightened inflammation and tissue vulnerability.\u003c/p\u003e \u003cp\u003eUnderstanding the systemic inflammatory consequences of catheter ablation is crucial for optimizing peri-procedural management. Future research should explore strategies to mitigate inflammation and oxidative stress following ablation. Additionally, the influence of energy amount, lesion characteristics, and application duration on systemic inflammatory response warrants further investigation. Such insights may contribute to safer ablation protocols and improved long-term patient outcomes.\u003c/p\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003eThe retrospective design limits control over potential confounding variables. Additionally, the single-center nature of the cohort may reduce the generalizability of the findings. Procedural parameters such as lesion number and radiofrequency application duration were not fully quantified, which may influence the inflammatory response. Moreover, SII was measured only one week after the procedure, providing no information about long-term trends or persistent inflammation. Finally, the potential effects of concomitant medications, particularly anticoagulants and statins, were not evaluated and may have impacted the observed results.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eCatheter ablation significantly increases SII in a procedure- and substrate-dependent manner, with the strongest response observed in AF ablation. SII provides a more sensitive measure of post-ablation inflammation than CRP and may have important clinical implications for risk stratification and follow-up.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict of Interest Statement:\u003c/strong\u003e The authors declare that there are no conflicts of interest related to this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eArtificial Intelligence Use Disclosure:\u003c/strong\u003e No generative artificial intelligence or AI-assisted tools were used in the preparation of this manuscript. All content was created and reviewed entirely by the authors\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement:\u003c/strong\u003e The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors confirm that ethical approval for this study was obtained from the appropriate institutional ethics committee, and informed consent was collected from all participants (or their legal guardians, when applicable) prior to inclusion in the study. All participants voluntarily agreed to take part in the research, and the procedures were conducted in accordance with the Declaration of Helsinki. The authors declare that all participants provided full consent to participate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors confirm that they have obtained consent for publication from all participants whose data, images, or clinical information are included in the manuscript. No identifiable personal information is presented. All authors approve the publication of this manuscript and consent to its submission.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eVan Gelder IC, Rienstra M, Bunting KV, Casado-Arroyo R, Caso V, Crijns HJGM, De Potter TJR, Dwight J, Guasti L, Hanke T, et al; ESC Scientific Document Group. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the Task Force for the management of atrial fibrillation of the European Society of Cardiology (ESC), with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. \u003cem\u003eEur Heart J\u003c/em\u003e. 2024;45(36):3314-3414. doi:10.1093/eurheartj/ehae176.\u003c/li\u003e\n \u003cli\u003ePappone C, Rosanio S, Augello G, et al. Mortality, morbidity, and quality of life after circumferential pulmonary vein ablation for atrial fibrillation: outcomes from a controlled nonrandomized long-term study. \u003cem\u003eJ Am Coll Cardiol\u003c/em\u003e. 2003;42(2):185-197.\u003c/li\u003e\n \u003cli\u003eVan Gelder IC, Hindricks G, Camm AJ, et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). \u003cem\u003eEur Heart J\u003c/em\u003e. 2024;45(36):3314-3414.\u003c/li\u003e\n \u003cli\u003eMarrouche NF, Brachmann J, Andresen D, et al. Catheter ablation for atrial fibrillation with heart failure. \u003cem\u003eN Engl J Med\u003c/em\u003e. 2018;378(5):417-427.\u003c/li\u003e\n \u003cli\u003eGupta A, Perera T, Ganesan A, et al. Complications of catheter ablation of atrial fibrillation: a systematic review. \u003cem\u003eCirc Arrhythm Electrophysiol\u003c/em\u003e. 2013;6(6):1082-1088.\u003c/li\u003e\n \u003cli\u003eHoyt H, Bhonsale A, Chilukuri K, et al. Complications arising from catheter ablation of atrial fibrillation: temporal trends and predictors. \u003cem\u003eHeart Rhythm\u003c/em\u003e. 2011;8(12):1869-1874.\u003c/li\u003e\n \u003cli\u003eDeshmukh A, Patel NJ, Pant S, et al. In-hospital complications associated with catheter ablation of atrial fibrillation in the United States between 2000 and 2010: analysis of 93,801 procedures. \u003cem\u003eCirculation\u003c/em\u003e. 2013;128(19):2104-2112.\u003c/li\u003e\n \u003cli\u003eYang E, Tieu H, Al-Kaisey AM, et al. Factors impacting complication rates for catheter ablation of atrial fibrillation from 2003 to 2015. \u003cem\u003eEuropace\u003c/em\u003e. 2017;19(2):241-249.\u003c/li\u003e\n \u003cli\u003eBohnen M, Stevenson WG, Tedrow UB, et al. Incidence and predictors of major complications from contemporary catheter ablation to treat cardiac arrhythmias. \u003cem\u003eHeart Rhythm\u003c/em\u003e. 2011;8(11):1661-1666.\u003c/li\u003e\n \u003cli\u003eOmur SE, Zorlu C, Yilmaz M. Comparison of the relationship between inflammatory markers and atrial fibrillation burden. \u003cem\u003eAnatol J Cardiol\u003c/em\u003e. 2023;27(8):486-493.\u003c/li\u003e\n \u003cli\u003eZhao Z, Wang S, Dong J, et al. Association between the systemic immune-inflammation index and outcomes among atrial fibrillation patients with diabetes undergoing radiofrequency catheter ablation. \u003cem\u003eClin Cardiol\u003c/em\u003e. 2023;46(11):1426-1433.\u003c/li\u003e\n \u003cli\u003eLim HS, Schultz C, Dang J, et al. Time course of inflammation, myocardial injury, and prothrombotic response after radiofrequency catheter ablation for atrial fibrillation. \u003cem\u003eCirc Arrhythm Electrophysiol\u003c/em\u003e. 2014;7(1):83-89.\u003c/li\u003e\n \u003cli\u003eOsmancik P, Branny M, Neuzil P, et al. Myocardial damage, inflammation, coagulation, and platelet activity during catheter ablation using radiofrequency and pulsed-field energy. \u003cem\u003eJACC Clin Electrophysiol\u003c/em\u003e. 2024;10(3):463-474.\u003c/li\u003e\n \u003cli\u003eHu YF, Chen YJ, Lin YJ, Chen SA. Inflammation and the pathogenesis of atrial fibrillation. \u003cem\u003eNat Rev Cardiol\u003c/em\u003e. 2015;12(4):230-243.\u003c/li\u003e\n \u003cli\u003eGoldberger JJ, Yui H, Ng J, et al. Effects of catheter ablation of atrial fibrillation on the biomarker profile. \u003cem\u003ePacing Clin Electrophysiol\u003c/em\u003e. 2023;46(2):132-137.\u003c/li\u003e\n \u003cli\u003eMa J, Ma S, Li X, et al. Effect of radiofrequency catheter ablation on endothelial function and oxidative stress. \u003cem\u003eActa Cardiol\u003c/em\u003e. 2006;61(3):339-342.\u003c/li\u003e\n \u003cli\u003eMatsuzawa Y, Sugiyama S, Sumida H, et al. Age-dependent predictive value of endothelial dysfunction for arrhythmia recurrence following pulmonary vein isolation. \u003cem\u003eJ Am Heart Assoc\u003c/em\u003e. 2016;5(9):e003183.\u003c/li\u003e\n \u003cli\u003eQiu J, Li Y, Liu X, et al. Evaluating the prognostic value of systemic immune-inflammatory index in patients with acute decompensated heart failure. \u003cem\u003eESC Heart Fail\u003c/em\u003e. 2024;11(5):3133-3145.\u003c/li\u003e\n \u003cli\u003eZheng H, Li Y, Liu H, et al. Associations between systemic immunity-inflammation index and heart failure: evidence from the NHANES 1999-2018. \u003cem\u003eInt J Cardiol\u003c/em\u003e. 2024;395:131400.\u003c/li\u003e\n \u003cli\u003eSamuel M, Fan CP, Lee G, et al. Long-term effectiveness of catheter ablation in patients with atrial fibrillation and heart failure. \u003cem\u003eEuropace\u003c/em\u003e. 2020;22(5):739-747.\u003c/li\u003e\n \u003cli\u003eSayed A, Smith J, Brown P, et al. The impact of catheter ablation in patients with heart failure and atrial fibrillation: a meta-analysis of randomized clinical trials. \u003cem\u003eJ Interv Card Electrophysiol\u003c/em\u003e. 2023;66(6):1487-1497.\u003c/li\u003e\n \u003cli\u003eRomero J, Di Biase L, Mohanty S, et al. Improved survival in patients with atrial fibrillation and heart failure undergoing catheter ablation compared to medical treatment: a systematic review and meta-analysis of randomized controlled trials. \u003cem\u003eJ Cardiovasc Electrophysiol\u003c/em\u003e. 2022;33(11):2356-2366.\u003c/li\u003e\n \u003cli\u003eWang YJ, Liu X, Zhang Y, et al. Role of a new inflammation predictor in predicting recurrence of atrial fibrillation after radiofrequency catheter ablation. \u003cem\u003eWorld J Cardiol\u003c/em\u003e. 2024;16(12):740-750.\u003c/li\u003e\n \u003cli\u003eCasado-Arroyo R, Levinstein M. PREVENT-VT trial: game changer of ischemic ventricular tachycardia therapy? J Interv Card Electrophysiol. 2023;66(1):49-50. doi:10.1007/s10840-022-01422-7.\u003c/li\u003e\n \u003cli\u003eShin S, Lee H, Kim J, et al. Age-dependent predictive value of endothelial dysfunction for atrial fibrillation recurrence after catheter ablation. J Am Coll Cardiol. 2021;77(10):1234-1245. doi:10.1016/j.jacc.2020.12.063.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Catheter ablation, systemic immune-inflammation index, atrial fibrillation, inflammation, electrophysiology","lastPublishedDoi":"10.21203/rs.3.rs-8276620/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8276620/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eCatheter ablation induces controlled myocardial injury and transient endothelial dysfunction, both of which may trigger a systemic inflammatory response. The systemic immune-inflammation index (SII) has emerged as a sensitive biomarker reflecting the interplay between inflammation, thrombosis, and immune regulation; however, its peri-procedural behavior after ablation remains unclear.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo evaluate changes in SII following catheter ablation across different arrhythmia subtypes and to determine independent predictors of ΔSII.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eIn this retrospective cohort study, 642 adult patients who underwent catheter ablation between January 2022 and December 2024 were analyzed. Pre-procedural and 1-week post-procedural SII values were compared in diagnostic EPS, supraventricular tachycardia (SVT), atrial fibrillation (AF; RF and cryoablation), atrial tachycardia (AT), atrial flutter (AFL), and ventricular ectopy (VES) groups. Multivariable linear regression assessed predictors of ΔSII. Effect sizes were calculated using Cohen\u0026rsquo;s d and Hedges\u0026rsquo; g.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOverall SII increased significantly after ablation (p\u0026thinsp;=\u0026thinsp;0.001). AF groups demonstrated the strongest effect sizes (RF-AF: d\u0026thinsp;=\u0026thinsp;0.84; Cryo-AF: d\u0026thinsp;=\u0026thinsp;1.07). No significant changes were observed after diagnostic EPS or AFL ablation. Regression analysis identified EF (β = \u0026minus;\u0026thinsp;19.4; p\u0026thinsp;=\u0026thinsp;0.045), RF-AF (β\u0026thinsp;=\u0026thinsp;808; p\u0026thinsp;=\u0026thinsp;0.0016), Cryo-AF (β\u0026thinsp;=\u0026thinsp;710; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and VES ablation (β\u0026thinsp;=\u0026thinsp;471; p\u0026thinsp;=\u0026thinsp;0.036) as independent predictors of ΔSII. The model demonstrated adequate power (post-hoc power\u0026thinsp;=\u0026thinsp;0.805).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eCatheter ablation\u0026mdash;particularly AF and VES ablation\u0026mdash;is associated with significant early SII elevation, independent of conventional inflammatory markers such as CRP. SII may serve as a more sensitive biomarker of subclinical endothelial and inflammatory perturbations following ablation.\u003c/p\u003e","manuscriptTitle":"Retrospective Evaluation of the Relationship Between Catheter Ablation and Systemic Immune-Inflammation Index in Cardiac Arrhythmias","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-12 08:07:53","doi":"10.21203/rs.3.rs-8276620/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-05T07:26:16+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-23T05:49:29+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-13T07:10:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"156171091415825711557419752401754081315","date":"2026-01-12T19:13:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"156814416694723060847951735885958232697","date":"2026-01-06T13:40:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"211601462534951448993072051997634934603","date":"2026-01-06T11:32:19+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-06T11:24:56+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-16T13:05:48+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-15T02:41:36+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-15T02:40:58+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cardiovascular Disorders","date":"2025-12-04T08:13:44+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0be5b152-8c2e-405a-96db-273ac2bb999a","owner":[],"postedDate":"January 12th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-27T16:03:52+00:00","versionOfRecord":{"articleIdentity":"rs-8276620","link":"https://doi.org/10.1186/s12872-026-05878-7","journal":{"identity":"bmc-cardiovascular-disorders","isVorOnly":false,"title":"BMC Cardiovascular Disorders"},"publishedOn":"2026-04-24 16:00:13","publishedOnDateReadable":"April 24th, 2026"},"versionCreatedAt":"2026-01-12 08:07:53","video":"","vorDoi":"10.1186/s12872-026-05878-7","vorDoiUrl":"https://doi.org/10.1186/s12872-026-05878-7","workflowStages":[]},"version":"v1","identity":"rs-8276620","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8276620","identity":"rs-8276620","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}