What is the clinical evidence from this study?

Study design: Cohort. Population: Atrial Fibrillation (n=654). Intervention: Metabolic syndrome vs. No metabolic syndrome. Primary outcome: Recurrence of atrial fibrillation (HR 1.64, 95% CI 1.07-2.49, p=0.022).

January 1, 2009Open Access

Metabolic Syndrome and Risk of Recurrence of Atrial Fibrillation After Catheter Ablation

RTRibo TangApple (Israel)JDJian-Zeng DongCapital Medical University XLXing-Peng LiuCapital Medical University

Key Result

Metabolic syndrome diagnosed prior to atrial fibrillation catheter ablation independently predicted a higher risk of AF recurrence (HR 1.64).

Study Design

Type

Cohort (n=654)

Multicenter

Structured PICO

Does metabolic syndrome increase the risk of atrial fibrillation recurrence in patients undergoing catheter ablation?

Population

654 patients with refractory atrial fibrillation undergoing index catheter ablation, followed for a mean of 470 days.

Exposure

Presence of Metabolic Syndrome (MetS) diagnosed prior to ablation, according to modified National Cholesterol Education Program-Adult Treatment Panel III criteria and Chinese ethnic criteria.

Comparator

Absence of Metabolic Syndrome (non-MetS).

Outcome

Incidence of atrial fibrillation recurrence.hard clinical

Metabolic syndrome is an independent predictor of atrial fibrillation recurrence following catheter ablation, highlighting the potential importance of metabolic risk factor management in this population.

Main Result

Hazard Ratio: 1.64 (95% CI 1.07–2.49)

Absolute Event Rate: 43.7% vs 30.5%

p-value: p=0.022

Limitations

Retrospective study design
Lack of data on inflammatory markers such as C-reactive protein
Role of obstructive sleep apnea was not determined
Potential underestimation of AF recurrence due to undetected asymptomatic episodes
Possible selection bias as the costly ablation procedure was mostly undergone by wealthier patients who may have a higher prevalence of metabolic syndrome

Abstract

BACKGROUND: Metabolic syndrome (MetS), as well as several risk factors of cardiovascular diseases, is known to be associated with atrial fibrillation (AF), but its impact on the recurrence of AF after catheter ablation has not been explored. METHODS AND RESULTS: The data for 654 consecutive AF patients who underwent an index circumferential pulmonary vein ablation were retrospectively analyzed. Of them, 323 (49.4%) had MetS according to the modified National Cholesterol Education Program-Adult Treatment Panel III criteria and Chinese ethnic criteria. After a mean follow-up of 470+/-323 (91-1,245) days, patients with MetS had a significantly higher incidence of AF recurrence (43.7%) compared with non-MetS patients (30.5%, P<0.001). Univariate analysis revealed that nonparoxysmal AF, left atrial size, MetS and body mass index were predictors of AF recurrence. Multivariate analysis revealed that MetS (hazard ratio =1.64, 95% confidence interval (CI) 1.07-2.49, P=0.022) and nonparoxysmal AF (hazard ratio =1.57, 95% CI 1.15-2.14, P=0.004) were independent predictors of AF recurrence. The major complications rate did not differ between the MetS and the non-MetS groups (1.86% vs 2.42%, P=0.621). CONCLUSIONS: MetS diagnosed prior to AF ablation is an independent predictor of AF recurrence.

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