Novel cholesterol-high-density lipoprotein-glucose index is associated with 1-year recurrence of atrial fibrillation after catheter ablation

Objective Insulin resistance (IR) plays a pivotal role in the pathogenesis of atrial fibrillation (AF). The novel cholesterol-high-density lipoprotein-glucose (CHG) index, which integrates total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and fasting blood glucose (FBG), has not been validated for predicting AF recurrence following radiofrequency catheter ablation (RFCA). This study aimed to evaluate the association between the CHG index and 1-year AF recurrence after RFCA, and to compare its performance with the triglyceride-glucose (TyG) index. Methods A retrospective cohort of 813 AF patients who underwent first-time RFCA was enrolled. The primary outcome was any atrial tachyarrhythmia lasting ≥ 30 s after a 3-month blanking period. Cox regression, ROC curve, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were used to assess predictive performance. Results During 1-year follow-up, 142 patients (17.5%) had recurrent atrial tachyarrhythmia, with significantly higher CHG levels in the recurrence group ( P < 0.001). Each unit increase in the CHG index was associated with a 4.23-fold higher risk of recurrence (HR = 4.231, 95% CI: 3.406–5.257, P < 0.001). The restricted cubic spline curve shows a dose-response relationship between CHG and AF recurrence. The CHG index yielded an AUC of 0.765, superior to TyG (AUC = 0.673). Adding the CHG index to the traditional risk model significantly improved NRI (0.434, P < 0.001) and IDI (0.200, P < 0.001), with greater improvement than adding the TyG index. Subgroup analyses demonstrated consistent predictive effects across different populations. Conclusions The CHG index is an independent risk marker for 1-year recurrence after AF ablation and demonstrates superior discriminative ability compared to the TyG index.