Triglyceride-glucose index and atrial fibrillation: a systematic review and meta-analysis

Background and objectives Insulin resistance (IR) plays a pivotal role in the onset and progression of atrial fibrillation (AF). As a simple, reliable surrogate marker of IR, the triglyceride-glucose (TyG) index has drawn growing attention for its association with AF. This study aimed to comprehensively evaluate the strength of the association between the TyG index and AF, as well as its specific subtypes including new-onset AF, AF recurrence after catheter ablation, and postoperative AF, via a systematic review and meta-analysis. Methods Relevant literature was systematically retrieved from PubMed, Web of Science, CNKI, Wanfang Data Knowledge Service Platform, and VIP Chinese Journal Database from their inception to September 30, 2025. Literature screening, data extraction and quality assessment (using the Newcastle-Ottawa Scale) were independently performed by two researchers. A random-effects model was adopted to calculate the pooled standardized mean difference (SMD) and odds ratio (OR) with 95% confidence intervals (CIs), so as to compare TyG index levels between AF and non-AF populations, and to assess the association of the TyG index (treated as both a continuous and categorical variable) with AF risk. Subgroup analysis, meta-regression and sensitivity analysis were conducted to explore sources of heterogeneity and verify the robustness of the results. Results A total of 19 observational studies were included, involving an overall sample of 25,376 participants. The meta-analysis yielded the following findings: ① Based on 15 studies, TyG index levels were significantly higher in AF patients than in non-AF individuals (SMD: 0.65; 95% CI: 0.34–0.95; I 2 = 98%; P < 0.001), and this association remained statistically significant in the new-onset AF (SMD = 0.55) and postoperative AF (SMD = 0.94) subgroups. ② Based on 11 studies, each 1-unit increment in the TyG index was associated with a 114% increase in overall AF risk (OR: 2.14; 95% CI: 1.73–2.65; I 2 = 81%; P < 0.001). Subgroup analysis demonstrated that this risk elevation was consistent across new-onset AF (OR = 2.04), post-ablation AF recurrence (OR = 1.85) and postoperative AF (OR = 3.78). ③ Based on 6 studies, the pooled adjusted hazard ratio of AF for the highest TyG index group was 211% higher than that for the lowest group (aHR = 3.11, 95% CI: 1.75–5.52; P < 0.001). High heterogeneity was detected across the included studies, but sensitivity analysis confirmed the robustness of the pooled results. Conclusions Current evidence, predominantly derived from Asian populations, indicates a significant positive association between the TyG index and AF risk. The TyG index may serve as a promising potential biomarker for predicting new-onset AF, post-ablation AF recurrence and postoperative AF in this population. Its generalizability to non-Asian populations requires further validation. Nevertheless, with the advantages of convenient measurement and low cost, the TyG index holds broad application prospects in clinical risk stratification and early prevention of AF.