Key result
Higher remnant cholesterol is linked to ~26% higher risk of tachyarrhythmia recurrence post-ablation.
Why the study?
The association between lipoproteins and atrial tachyarrhythmia recurrence after catheter ablation remains inconclusive and has been based only on routine lipid measurements.
Does an atherogenic NMR-derived baseline lipoprotein profile increase the risk of atrial tachyarrhythmia recurrence after catheter ablation?
Cohort (n=357)
Does an atherogenic NMR-derived baseline lipoprotein profile increase the risk of atrial tachyarrhythmia recurrence after catheter ablation?
Hazard Ratio: 1.26 (95% CI 1.06–1.51)
An atherogenic NMR-derived lipoprotein profile characterized by elevated remnant cholesterol, VLDL, and IDL is associated with a higher risk of atrial tachyarrhythmia recurrence post-catheter ablation.
Remnant cholesterol may refine post-ablation recurrence risk stratification; leaves open whether targeting atherogenic lipoproteins improves outcomes.
Background Lipoproteins could be potential biomarkers of atrial tachyarrhythmia recurrence (TAR) after catheter ablation; however, their association remains inconclusive and based exclusively on routine lipid measurements. Nuclear magnetic resonance (NMR) enables detailed lipoprotein characterization beyond conventional assays. Objective To identify a baseline NMR-derived lipoprotein profile associated with the risk of TAR after catheter ablation. Methods We conducted a case-cohort study (212 cases and 238 participants in a random sub-cohort, with 93 overlapping cases) nested in the PREDIMAR (PRevención con DIeta Mediterránea de Arritmias Recurrentes) trial. Conventional lipoprotein profiles were measured using the Pentra C-200 and advanced lipoprotein profiles were assessed by NMR. Lipoprotein values were normalized and scaled to one standard deviation using Blom's inverse normal transformation. Cox models were used to assess the associations between baseline lipoproteins and TAR. Additionally, a cholesteryl ester transfer (CETP)-mediated lipoprotein exchange score was constructed and evaluated. Results After 18-month follow-up, higher baseline remnant cholesterol (hazard ratio=1.26, 95% confidence interval=1.06-1.51, per SD), higher cholesterol and triglyceride content in very-low-density lipoproteins (VLDL) (hazard ratio perSD = 1.22, 95% confidence interval=1.03-1.46) or in intermediate-density lipoproteins (IDL) (hazard ratio perSD = 1.29, 95% confidence interval=1.09-1.52), showed increased risks of TAR. Higher triglyceride-to-HDL cholesterol ratio was directly associated, and higher triglyceride-to-VLDL cholesterol and triglyceride-to-IDL cholesterol ratios were inversely associated with recurrence. A CETP-mediated lipoprotein exchange score was directly associated with recurrence. Conclusion An atherogenic lipoprotein profile characterized by elevated remnant cholesterol is associated with a higher risk of TAR after catheter ablation.
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Belzunce et al. (2026) conducted a cohort in Atrial tachyarrhythmia recurrence after catheter ablation (n=357). Elevated baseline remnant cholesterol (per SD) vs. Lower baseline remnant cholesterol levels was evaluated on Atrial tachyarrhythmia recurrence (TAR) (HR 1.26, 95% CI 1.06-1.51). Higher baseline remnant cholesterol was associated with an increased risk of atrial tachyarrhythmia recurrence after catheter ablation (HR 1.26; 95% CI 1.06-1.51).
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