Impact of Metabolic Syndrome on Procedural Outcomes in Patients With Atrial Fibrillation Undergoing Catheter Ablation

Study Questions:

Does metabolic syndrome (MS) affect the outcomes of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF)?

Methods:

RFCA of AF (paroxysmal in 29%) was performed in 1,496 patients. Efficacy was assessed with serial 7-day Holter monitors and quality of life (QoL) was measured with the Medical Outcomes Study SF-36 Health Survey at baseline and 12 months post-ablation. Outcomes were compared between 485 patients (mean age 64 years) with MS (hypertension, diabetes, dyslipidemia, and obesity) and 1,011 patients (mean age 62 years) without MS.

Results:

The AF recurrence rate after a single procedure at a mean follow-up of 21 months was significantly higher in patients with (39%) than without (32%) MS. Baseline QoL scores were significantly lower in the MS group. QoL improved significantly in both groups among patients without recurrent AF and did not improve among patients with recurrent AF. Among patients with nonparoxysmal AF, independent predictors of recurrent AF included MS (hazard ratio [HR], 1.42), female gender (HR, 1.28), and C-reactive protein (CRP) ≥0.9 mg/dl (HR, 1.87). These variables were not predictive of recurrent AF among patients with paroxysmal AF.

Conclusions:

MS, female gender, and baseline CRP level are associated with lower efficacy after RFCA of nonparoxysmal AF. QoL improves to a similar agree in patients with and without MS when RFCA is successful.

Perspective:

Prior studies have demonstrated that markers of inflammation are associated with recurrent AF in various settings including after open heart surgery, transthoracic cardioversion, and catheter ablation. Each of the components of MS is associated with inflammation, and this provides at least one explanation for the link between MS and recurrent AF.

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Diabetes and Cardiometabolic Disease, Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Prevention, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Hypertension

Keywords: Inflammation, Electric Countershock, Health Surveys, Metabolic Syndrome X, Dyslipidemias, C-Reactive Protein, Biological Markers, Obesity, Cardiac Surgical Procedures, Catheter Ablation, Hypertension, Diabetes Mellitus


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