Pre-ablation triglyceride–glucose (TyG) index as a predictor of atrial fibrillation recurrence after catheter ablation: a meta-analysis

Background Atrial fibrillation (AF) recurrence after catheter ablation remains common. Insulin resistance contributes to atrial remodeling and may influence post-ablation outcomes. The triglyceride–glucose (TyG) index is a simple surrogate of insulin resistance; however, its prognostic value in patients undergoing AF ablation has not been systematically evaluated. Objectives To evaluate the association between pre-ablation TyG index and AF recurrence following catheter ablation. Methods A systematic review and DerSimonian–Laird random-effects meta-analysis of observational cohort studies were conducted, including studies reporting multivariable-adjusted hazard ratios (HRs) for the association between TyG index and AF recurrence. Analyses were performed using RevMan 5.4.1. The primary analysis pooled continuous TyG index estimates, while a secondary exploratory analysis pooled categorical comparisons (high vs. low TyG index). Heterogeneity and robustness were assessed through sensitivity analyses. Results Five studies comprising 4749 participants were included in the primary analysis. A higher pre-ablation TyG index was significantly associated with increased AF recurrence (pooled HR 1.54, 95% CI 1.21–1.97, P = 0.0004), with substantial heterogeneity. Sensitivity analysis confirmed robustness of this association. The secondary categorical analysis, including two studies (high vs. low TyG tertiles), did not show a statistically significant association with AF recurrence (pooled HR 1.54, 95% CI 0.95–2.50, P > 0.05). However, methodological differences and analytic constraints are more likely than absence of a true association. Conclusions A higher pre-ablation TyG index as a continuous variable is independently associated with AF recurrence after catheter ablation. Categorical TyG analyses did not demonstrate a significant association, although methodological and analytical limitations make it inconclusive. Nevertheless, TyG index may represent a promising marker for risk stratification; however, given the predominantly Chinese cohorts, these findings should be interpreted with caution and support the need for further studies for external validation before incorporation of TyG index into pre-procedural risk stratification models.