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Impact of metabolic syndrome on the risk of atrial fibrillation recurrence after catheter ablation: systematic review and meta-analysis

  • Kueiyu Joshua LinEmail author
  • Soung Ick Cho
  • Nidhish Tiwari
  • Michael Bergman
  • Jorge R. Kizer
  • Eugen C. Palma
  • Cynthia C. Taub
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Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusions

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.

Keywords

Pulmonary vein isolation Syndrome X Glucose intolerance Hyperlipidemia Insulin resistance 

Notes

Financial support

Dr. Kizer is supported by R01 HL094555 from the National Heart, Lung and Blood Institute.

Conflict of interest

None declared.

References

  1. 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. 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
  3. 3.
    Cappato, R., Calkins, H., Chen, S. A., Davies, W., Iesaka, Y., Kalman, J., et al. (2005). Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation, 111, 1100–1105.PubMedCrossRefGoogle Scholar
  4. 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. 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
  6. 6.
    Mohanty, S., Mohanty, P., Di Biase, L., Bai, R., Pump, A., Santangeli, P., et al. (2012). Impact of metabolic syndrome on procedural outcomes in patients with atrial fibrillation undergoing catheter ablation. Journal of the American College of Cardiology, 59, 1295–1301.PubMedCrossRefGoogle Scholar
  7. 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
  8. 8.
    Chang, S. L., Tuan, T. C., Tai, C. T., Lin, Y. J., Lo, L. W., Hu, Y. F., et al. (2009). Comparison of outcome in catheter ablation of atrial fibrillation in patients with versus without the metabolic syndrome. American Journal of Cardiology, 103, 67–72.PubMedCrossRefGoogle Scholar
  9. 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
  10. 10.
    Shah, A. N., Mittal, S., Sichrovsky, T. C., Cotiga, D., Arshad, A., Maleki, K., et al. (2008). Long-term outcome following successful pulmonary vein isolation: pattern and prediction of very late recurrence. Journal of Cardiovascular Electrophysiology, 19, 661–667.PubMedCrossRefGoogle Scholar
  11. 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. 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. 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
  14. 14.
    Andrade, J. G., Khairy, P., Verma, A., Guerra, P. G., Dubuc, M., Rivard, L., et al. (2012). Early recurrence of atrial tachyarrhythmias following radiofrequency catheter ablation of atrial fibrillation. Pacing and Clinical Electrophysiology: PACE, 35, 106–116.PubMedCrossRefGoogle Scholar
  15. 15.
    Higgins, J. P., & Thompson, S. G. (2002). Quantifying heterogeneity in a meta-analysis. Statistics in Medicine, 21, 1539–1558.PubMedCrossRefGoogle Scholar
  16. 16.
    Begg, C. B., & Mazumdar, M. (1994). Operating characteristics of a rank correlation test for publication bias. Biometrics, 50, 1088–1101.PubMedCrossRefGoogle Scholar
  17. 17.
    Wokhlu, A., Hodge, D. O., Monahan, K. H., Asirvatham, S. J., Friedman, P. A., Munger, T. M., et al. (2010). Long-term outcome of atrial fibrillation ablation: impact and predictors of very late recurrence. Journal of Cardiovascular Electrophysiology, 21, 1071–1078.PubMedCrossRefGoogle Scholar
  18. 18.
    Berruezo, A., Tamborero, D., Mont, L., Benito, B., Tolosana, J. M., Sitges, M., et al. (2007). Pre-procedural predictors of atrial fibrillation recurrence after circumferential pulmonary vein ablation. European Heart Journal, 28, 836–841.PubMedCrossRefGoogle Scholar
  19. 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
  20. 20.
    Chao, T. F., Sung, S. H., Wang, K. L., Lin, Y. J., Chang, S. L., Lo, L. W., et al. (2011). Associations between the atrial electromechanical interval, atrial remodelling and outcome of catheter ablation in paroxysmal atrial fibrillation. Heart, 97, 225–230.PubMedCrossRefGoogle Scholar
  21. 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. 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. 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
  24. 24.
    Jongnarangsin, K., Chugh, A., Good, E., Mukerji, S., Dey, S., Crawford, T., et al. (2008). Body mass index, obstructive sleep apnea, and outcomes of catheter ablation of atrial fibrillation. Journal of Cardiovascular Electrophysiology, 19, 668–672.PubMedCrossRefGoogle Scholar
  25. 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. 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. 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. 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. 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
  30. 30.
    Wong, C. X., Abed, H. S., Molaee, P., Nelson, A. J., Brooks, A. G., Sharma, G., et al. (2011). Pericardial fat is associated with atrial fibrillation severity and ablation outcome. Journal of the American College of Cardiology, 57, 1745–1751.PubMedCrossRefGoogle Scholar
  31. 31.
    Deepa, M., Farooq, S., Datta, M., Deepa, R., & Mohan, V. (2007). Prevalence of metabolic syndrome using WHO, ATPIII and IDF definitions in Asian Indians: the Chennai Urban Rural Epidemiology Study (CURES-34). Diabetes/Metabolism Research and Reviews, 23, 127–134.PubMedCrossRefGoogle Scholar
  32. 32.
    Sundstrom, J., Riserus, U., Byberg, L., Zethelius, B., Lithell, H., & Lind, L. (2006). Clinical value of the metabolic syndrome for long term prediction of total and cardiovascular mortality: prospective, population based cohort study. BMJ, 332, 878–882.PubMedCentralPubMedCrossRefGoogle Scholar
  33. 33.
    Stang, A. (2010). Critical evaluation of the Newcastle–Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. European Journal of Epidemiology, 25, 603–605.PubMedCrossRefGoogle Scholar
  34. 34.
    Konings, K. T., Kirchhof, C. J., Smeets, J. R., Wellens, H. J., Penn, O. C., & Allessie, M. A. (1994). High-density mapping of electrically induced atrial fibrillation in humans. Circulation, 89, 1665–1680.PubMedCrossRefGoogle Scholar
  35. 35.
    Duval, S., & Tweedie, R. (2000). Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics, 56, 455–463.PubMedCrossRefGoogle Scholar
  36. 36.
    Rosenberg, M. S. (2005). The file-drawer problem revisited: a general weighted method for calculating fail-safe numbers in meta-analysis. Evolution: International Journal of Organic Evolution, 59, 464–468.CrossRefGoogle Scholar
  37. 37.
    Sterne, J. A., Gavaghan, D., & Egger, M. (2000). Publication and related bias in meta-analysis: power of statistical tests and prevalence in the literature. Journal of Clinical Epidemiology, 53, 1119–1129.PubMedCrossRefGoogle Scholar
  38. 38.
    Wyse, D. G., & Gersh, B. J. (2004). Atrial fibrillation: a perspective: thinking inside and outside the box. Circulation, 109, 3089–3095.PubMedCrossRefGoogle Scholar
  39. 39.
    Tanaka, K., Zlochiver, S., Vikstrom, K. L., Yamazaki, M., Moreno, J., Klos, M., et al. (2007). Spatial distribution of fibrosis governs fibrillation wave dynamics in the posterior left atrium during heart failure. Circulation Research, 101, 839–847.PubMedCrossRefGoogle Scholar
  40. 40.
    Munger, T. M., Dong, Y. X., Masaki, M., Oh, J. K., Mankad, S. V., Borlaug, B. A., et al. (2012). Electrophysiological and hemodynamic characteristics associated with obesity in patients with atrial fibrillation. Journal of the American College of Cardiology, 60, 851–860.PubMedCrossRefGoogle Scholar
  41. 41.
    Wang, T. J., Parise, H., Levy, D., D’Agostino, R. B., Sr., Wolf, P. A., Vasan, R. S., et al. (2004). Obesity and the risk of new-onset atrial fibrillation. JAMA : the Journal of the American Medical Association, 292, 2471–2477.CrossRefGoogle Scholar
  42. 42.
    Schotten, U., Neuberger, H. R., & Allessie, M. A. (2003). The role of atrial dilatation in the domestication of atrial fibrillation. Progress in Biophysics and Molecular Biology, 82, 151–162.PubMedCrossRefGoogle Scholar
  43. 43.
    Dandona, P., Aljada, A., Chaudhuri, A., Mohanty, P., & Garg, R. (2005). Metabolic syndrome: a comprehensive perspective based on interactions between obesity, diabetes, and inflammation. Circulation, 111, 1448–1454.PubMedCrossRefGoogle Scholar
  44. 44.
    Korantzopoulos, P., Kolettis, T. M., Galaris, D., & Goudevenos, J. A. (2007). The role of oxidative stress in the pathogenesis and perpetuation of atrial fibrillation. International Journal of Cardiology, 115, 135–143.PubMedCrossRefGoogle Scholar
  45. 45.
    Ng, C. Y., Liu, T., Shehata, M., Stevens, S., Chugh, S. S., & Wang, X. (2011). Meta-analysis of obstructive sleep apnea as predictor of atrial fibrillation recurrence after catheter ablation. The American Journal of Cardiology, 108, 47–51.PubMedCrossRefGoogle Scholar
  46. 46.
    Dewire, J., & Calkins, H. (2010). State-of-the-art and emerging technologies for atrial fibrillation ablation. Nature Reviews Cardiology, 7, 129–138.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Kueiyu Joshua Lin
    • 1
    • 2
    Email author
  • Soung Ick Cho
    • 2
  • Nidhish Tiwari
    • 2
  • Michael Bergman
    • 2
  • Jorge R. Kizer
    • 3
    • 4
  • Eugen C. Palma
    • 3
  • Cynthia C. Taub
    • 3
  1. 1.Department of EpidemiologyHarvard School of Public HealthBostonUSA
  2. 2.Department of MedicineJacobi Medical Center and Albert Einstein College of MedicineBronxUSA
  3. 3.Department of MedicineMontefiore Medical Center and Albert Einstein College of MedicineBronxUSA
  4. 4.Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxUSA

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