Effect of Insulin Resistance on Recurrence After Radiofrequency Catheter Ablation in Patients with Atrial Fibrillation

Background Recurrence after atrial fibrillation(AF) ablation has many risk factors. the relationship between the recurrence rate after ablation and IR in the non-diabetic patients with AF is not clear. Methods Retrospective cohort study enrolled AF patients without diabetes who underwent ablation between 2018~2019 in the first affiliated hospital of zhengzhou university. Homeostasis model assessment of insulin resistance (HOMA‐IR) was calculated and a value of ≥2.69 was defined as insulin resistant(IR). The patients were categaried into two groups: those with HOMA‐IR<2.69 in group 1(n=163); HOMA‐IR≥2.69 in group 2 (n=69). Multivariable adjusted Cox proportional hazard models were performed to compare the risk of AF recurrence after ablation. The definition of AF recurrence was documented AF, atrial flutter, or atrial tachycardia lasting >30 seconds recorded in ECG or 24‐hour Holter monitoring after 3 months blanking period. Results 232 AF patients receiving ablation were enrolled and the median age was 59.5±11.3 years . There were 166 cases of paroxysmal AF and 66 cases of persistent AF. Patients with IR (n=69)were more likely to have Dyslipidemia, higher fasting blood glucose and fasting insulin than those in non-IR group. Patients with IR also were more likely to recieve antiarrhythmic drugs before ablation. After a mean follow‐up of 322±85 days, 62(26.7%) patients had documented recurrence of AF. Multivariable analysis showed that HOMA-IR value and left atrial diameter（LAD）were independent risk factors for recurrence after AF ablation (HR: 1.259, 95% CI:1.086~1.460, P=0.002; HR: 1.043, 95% CI:1.005~1.083, P=0.025; respectively). Conclusions HOMA-IR and LAD are independent risk factors for AF recurrence after ablation in patients without diabetes.