Impact of metabolic syndrome on the risk of atrial fibrillation recurrence after catheter ablation: systematic review and meta-analysis
- 434 Downloads
The impact of metabolic syndrome (MetS) on recurrence of atrial fibrillation (AF) after catheter ablation remains uncertain. We conducted a meta-analysis to summarize the relative risks (RR) of AF recurrence after catheter ablation in patients with vs. without MetS and its components.
Among 839 articles identified from PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials, we included 23 studies with a total of 12,924 patients (7,594 with paroxysmal AF and 5,330 with nonparoxysmal AF) for analysis. Five of these had complete information on MetS components. Variables assessed comprised study design and population characteristics, AF ablation methods, use of anti-arrhythmic drugs, AF recurrence ascertainment methods, adjustment variables, and other quality indicators.
Our meta-analysis found an elevated risk of AF recurrence after ablation in patients with vs. without MetS (pooled RR, 1.63; 95 % confidence interval (CI), 1.25–2.12). Among components of MetS, hypertension was a predictor of AF post-ablation recurrence in studies without adjustment for other MetS components (RR, 1.62; 95 % CI, 1.23–2.13) but not in those adjusting for two or more additional MetS components (RR, 1.03; 95 % CI, 0.88–1.20). There was a borderline association between overweight/obesity and AF recurrence after ablation (RR, 1.27; 95 % CI, 0.99–1.64).
MetS is associated with an increased risk of AF recurrence after catheter ablation. Further study of the MetS and its components as determinants of AF risk could help refine patient selection and improve procedural outcomes.
KeywordsPulmonary vein isolation Syndrome X Glucose intolerance Hyperlipidemia Insulin resistance
Dr. Kizer is supported by R01 HL094555 from the National Heart, Lung and Blood Institute.
Conflict of interest
- 1.Go, A. S., Hylek, E. M., Phillips, K. A., Chang, Y., Henault, L. E., Selby, J. V., et al. (2001). Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA : the Journal of the American Medical Association, 285, 2370–2375.CrossRefGoogle Scholar
- 2.Fuster, V., Ryden, L. E., Cannom, D. S., Crijns, H. J., Curtis, A. B., Ellenbogen, K. A., et al. (2011). ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation, 123, e269–e367.PubMedCrossRefGoogle Scholar
- 4.Patel, D., Mohanty, P., Di Biase, L., Shaheen, M., Lewis, W. R., Quan, K., et al. (2010). Safety and efficacy of pulmonary vein antral isolation in patients with obstructive sleep apnea: the impact of continuous positive airway pressure. Circulation Arrhythmia and Electrophysiology, 3, 445–451.PubMedCrossRefGoogle Scholar
- 5.Arya, A., Hindricks, G., Sommer, P., Huo, Y., Bollmann, A., Gaspar, T., et al. (2010). Long-term results and the predictors of outcome of catheter ablation of atrial fibrillation using steerable sheath catheter navigation after single procedure in 674 patients. Europace, 12, 173–180.Google Scholar
- 7.Alberti, K. G., Eckel, R. H., Grundy, S. M., Zimmet, P. Z., Cleeman, J. I., Donato, K. A., et al. (2009). Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation, 120, 1640–1645.PubMedCrossRefGoogle Scholar
- 9.Chao, T. F., Suenari, K., Chang, S. L., Lin, Y. J., Lo, L. W., Hu, Y. F., et al. (2010). Atrial substrate properties and outcome of catheter ablation in patients with paroxysmal atrial fibrillation associated with diabetes mellitus or impaired fasting glucose. American Journal of Cardiology, 106, 1615–1620.PubMedCrossRefGoogle Scholar
- 11.Cai L, Yin Y, Ling Z, Su L, Liu Z, Wu J, Du H, Lan X, Fan J, Chen W, Xu Y, Zhou P, Zhu J, Zrenner B. (2013) Predictors of late recurrence of atrial fibrillation after catheter ablation. International Journal of Cardiology 164:82–87Google Scholar
- 12.Berkowitsch, A., Kuniss, M., Greiss, H., Wojcik, M., Zaltsberg, S., Lehinant, S., et al. (2012). Impact of impaired renal function and metabolic syndrome on the recurrence of atrial fibrillation after catheter ablation: a long term follow-up. Pacing and Clinical Electrophysiology: PACE, 35, 532–543.PubMedCrossRefGoogle Scholar
- 13.Tang, R. B., Dong, J. Z., Liu, X. P., Long, D. Y., Yu, R. H., Kalifa, J., et al. (2009). Metabolic syndrome and risk of recurrence of atrial fibrillation after catheter ablation. Circulation Journal, 3, 438–443.Google Scholar
- 19.Bhargava, M., Di Biase, L., Mohanty, P., Prasad, S., Martin, D. O., Williams-Andrews, M., et al. (2009). Impact of type of atrial fibrillation and repeat catheter ablation on long-term freedom from atrial fibrillation: results from a multicenter study. Heart Rhythm: the Official Journal of the Heart Rhythm Society, 6, 1403–1412.CrossRefGoogle Scholar
- 21.Chao, T. F., Lin, Y. J., Chang, S. L., Lo, L. W., Hu, Y. F., Tuan, T. C., et al. (2011). Associations between renal function, atrial substrate properties and outcome of catheter ablation in patients with paroxysmal atrial fibrillation. Circulation Journal: Official Journal of the Japanese Circulation Society, 75, 2326–2332.CrossRefGoogle Scholar
- 22.Chilukuri, K., Dalal, D., Marine, J. E., Scherr, D., Henrikson, C. A., Cheng, A., et al. (2009). Predictive value of obstructive sleep apnoea assessed by the Berlin Questionnaire for outcomes after the catheter ablation of atrial fibrillation. Europace, 11, 896–901.Google Scholar
- 23.Hwang, H. J., Lee, J. M., Joung, B., Lee, B. H., Kim, J. B., Lee, M. H., et al. (2010). Atrial Electroanatomical remodeling as a determinant of different outcomes between two current ablation strategies: circumferential pulmonary vein isolation vs pulmonary vein isolation. Clinical Cardiology, 33, E69–E74.CrossRefGoogle Scholar
- 25.Khaykin, Y., Oosthuizen, R., Zarnett, L., Essebag, V., Parkash, R., Seabrook, C., et al. (2011). Clinical predictors of arrhythmia recurrences following pulmonary vein antrum isolation for atrial fibrillation: predicting arrhythmia recurrence post-PVAI. Journal of Cardiovascular Electrophysiology, 22, 1206–1214.PubMedCrossRefGoogle Scholar
- 26.Letsas, K. P., Weber, R., Burkle, G., Mihas, C. C., Minners, J., Kalusche, D., et al. (2009). Pre-ablative predictors of atrial fibrillation recurrence following pulmonary vein isolation: the potential role of inflammation. Europace, 11, 158–163.Google Scholar
- 27.Letsas KP, Siklody CH, Korantzopoulos P, Weber R, Burkle G, Mihas CC, Kalusche D, Arentz T. (2013) The impact of body mass index on the efficacy and safety of catheter ablation of atrial fibrillation. International Journal of Cardiology 164:94–98Google Scholar
- 28.Okumura, Y., Watanabe, I., Nakai, T., Ohkubo, K., Kofune, T., Kofune, M., et al. (2011). Impact of biomarkers of inflammation and extracellular matrix turnover on the outcome of atrial fibrillation ablation: importance of matrix metalloproteinase-2 as a predictor of atrial fibrillation recurrence. Journal of Cardiovascular Electrophysiology, 22, 987–993.PubMedCrossRefGoogle Scholar
- 29.Themistoclakis, S., Schweikert, R. A., Saliba, W. I., Bonso, A., Rossillo, A., Bader, G., et al. (2008). Clinical predictors and relationship between early and late atrial tachyarrhythmias after pulmonary vein antrum isolation. Heart Rhythm : the official journal of the Heart Rhythm Society, 5, 679–685.CrossRefGoogle Scholar