NPPA and atrial fibrillation: Cardiac stress biomarkers like N-terminal pro-brain natriuretic peptide(NT-pro-BNP), brain natriuretic peptide (BNP), and atrial natriuretic peptide(ANP) were consistently elevated in patients with poor outcomes, reflectingelevated atrial pressure and stretch, leading to progressive atrial enlargementand remodeling, thereby heightening susceptibility to AF recurrence [51].Genetic factors also play a crucial role, with the 4q25 mutation and altered paired-like homeodomain transcription factor 2 (PITX2) messenger RNA (mRNA) expression levels being associated with higherrecurrence risks [52].