Blood lipid levels and recurrence of atrial fibrillation after radiofrequency catheter ablation: a prospective study
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The relation between dyslipidemia and atrial fibrillation (AF) development remains controversial. We conducted a prospective study to investigate the association of lipids with the risk of recurrence of AF after radiofrequency catheter ablation (RFCA).
This study enrolled 287 consecutive patients who underwent initial circumferential pulmonary vein ablation (CPVA). Fasting levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) were measured at baseline before ablation. Patients were classified according to lipid quartiles. AF recurrence was confirmed by 48-h electrocardiograms at follow-up visits.
A total of 71 patients (24.7%) experienced AF recurrence during 3 to 12 months after ablation. By univariate Cox regression survival analysis, TC (HR, 0.63; 95%CI, 0.48–0.82), LDL-C (HR, 0.61; 95%CI, 0.44–0.84), non-paroxysmal AF type (HR, 2.56; 95%CI, 1.52–4.21), and left atrial diameter (HR, 2.18; 95%CI, 1.46–3.24) were significantly associated with AF recurrence. By multivariate Cox regression survival analysis, lower quartiles of TC (HR, 3.66; 95%CI, 1.56–8.56) and LDL-C (HR, 2.28; 95%CI 1.09–4.77) were associated with higher risk of AF recurrence compared with the highest quartiles. After adjustment by sex, lower TC (HR, 11.70; 95%CI, 2.79–49.13) and LDL-C (HR, 11.00; 95%CI, 2.77–43.72) levels were associated with the recurrence of AF in women, but not in men. HDL-C and TG levels showed no association with AF recurrence in both genders.
TC and LDL-C levels were negatively correlated with AF recurrence after RFCA in women. HDL-C and TG were not independently associated with AF recurrence in both genders.
KeywordsAtrial fibrillation recurrence Radiofrequency catheter ablation Cholesterol
We gratefully acknowledge all the participants in our study and we also thank International Science Editing (http://www.internationalscienceediting.com) for editing this manuscript.
Yunpeng Shang, Nan Chen, and Qiqi Wang conceived the idea for the research, wrote the framework, and drafted the manuscript as the principal author. Chengui Zhuo and Jianqiang Zhao were responsible for the data analysis and revision of the paper and made substantial contributions to the study conception and framework and design. Ning Lv and Yuan Huang performed the statistical analysis and made substantial contributions to the study conception and framework. All authors read and approved the final manuscript.
This study was supported by the National Science Foundation for Young Scholars of China (Grant nos. 30900612 and 81800231), the Clinical Research Fund of Zhejiang Provincial Medical Association (2015ZYC-A16 and 2018ZYC-A11), the Grant of Medical Science Research Foundation of Zhejiang Province (Grant no. 2018ZD017), grants from the Zhejiang Provincial Natural Science Foundation (Grant no. LY15H020002 and Y17H020020), and a grant from the Department of Science and Technology, Zhejiang Province (Grant no. LGF19H020011), People’s Republic of China.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Ethics approval and consent to participate
This study was approved by the Research Ethics Committee of the First Affiliated Hospital of Zhejiang University.
Informed consent was obtained from all individual participants included in the study.
- 1.Allan V, Honarbakhsh S, Casas J, Wallace J, Hunter R, Schilling R, et al. Are cardiovascular risk factors also associated with the incidence of atrial fibrillation? A systematic review and field synopsis of 23 factors in 32 population-based cohorts of 20 million participants. Thromb Haemost. 2017;117(5):837–50.Google Scholar
- 2.Annoura M, Ogawa M, Kumagai K, Zhang B, Saku K, Arakawa K. Cholesterol paradox in patients with paroxysmal atrial fibrillation. Cardiology. 1999;92(1):21–7.Google Scholar
- 3.Mora S, Akinkuolie A, Sandhu R, Conen D, Albert C. Paradoxical association of lipoprotein measures with incident atrial fibrillation. Circ Arrhythm Electrophysiol. 2014;7(4):612–9.Google Scholar
- 4.Psaty B, Manolio T, Kuller L, Kronmal R, Cushman M, Fried L, et al. Incidence of and risk factors for atrial fibrillation in older adults. Circulation. 1997;96(7):2455–61.Google Scholar
- 5.Mourtzinis G, Kahan T, Bengtsson Boström K, Schiöler L, Cedstrand Wallin L, Hjerpe P, et al. Relation between lipid profile and new-onset atrial fibrillation in patients with systemic hypertension (from the Swedish primary care cardiovascular database [SPCCD]). Am J Cardiol. 2018;122(1):102–7.Google Scholar
- 6.Li X, Gao L, Wang Z, Guan B, Guan X, Wang B, et al. Lipid profile and incidence of atrial fibrillation: a prospective cohort study in China. Clin Cardiol. 2018;41(3):314–20.Google Scholar
- 7.Haïssaguerre M, Gencel L, Fischer B, Le Métayer P, Poquet F, Marcus F, et al. Successful catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 1994;5(12):1045–52.Google Scholar
- 8.Cheema A, Vasamreddy CR, Dalal D, Marine JE, Dong J, Henrikson CA, et al. Long-term single procedure efficacy of catheter ablation of atrial fibrillation. J Interv Card Electrophysiol : an international journal of arrhythmias and pacing. 2006;15(3):145–55.Google Scholar
- 9.Chang S, Tuan T, Tai C, Lin Y, Lo L, Hu Y, et al. Comparison of outcome in catheter ablation of atrial fibrillation in patients with versus without the metabolic syndrome. Am J Cardiol. 2009;103(1):67–72.Google Scholar
- 10.Mohanty S, Mohanty P, Di Biase L, Bai R, Pump A, Santangeli P, et al. Impact of metabolic syndrome on procedural outcomes in patients with atrial fibrillation undergoing catheter ablation. J Am Coll Cardiol. 2012;59(14):1295–301.Google Scholar
- 11.Calkins H, Hindricks G, Cappato R, Kim Y, Saad E, Aguinaga L, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm. 2017;14(10):e275–444.Google Scholar
- 12.Lopez F, Agarwal S, Maclehose R, Soliman E, Sharrett A, Huxley R, et al. Blood lipid levels, lipid-lowering medications, and the incidence of atrial fibrillation: the atherosclerosis risk in communities study. Circ Arrhythm Electrophysiol. 2012;5(1):155–62.Google Scholar
- 13.Alonso A, Yin X, Roetker N, Magnani J, Kronmal R, Ellinor P, et al. Blood lipids and the incidence of atrial fibrillation: the multi-ethnic study of atherosclerosis and the Framingham heart study. J Am Heart Assoc. 2014;3(5):e001211.Google Scholar
- 14.Jiang H, Wang W, Wang C, Xie X, Hou Y. Association of pre-ablation level of potential blood markers with atrial fibrillation recurrence after catheter ablation: a meta-analysis. Europace. 2017;19(3):392–400.Google Scholar
- 15.Quist-Paulsen P. Statins and inflammation: an update. Curr Opin Cardiol. 2010;25(4):399–405.Google Scholar
- 16.Suleiman M, Koestler C, Lerman A, Lopez-Jimenez F, Herges R, Hodge D, et al. Atorvastatin for prevention of atrial fibrillation recurrence following pulmonary vein isolation: a double-blind, placebo-controlled, randomized trial. Heart Rhythm. 2012;9(2):172–8.Google Scholar
- 17.Yang Q, Qi X, Dang Y, Song X, Hao X. Impact of statin therapy on recurrence of persistent atrial fibrillation after electrical cardioversion: a meta-analysis. Zhonghua Xin Xue Guan Bing Za Zhi. 2015;43(11):994–8.Google Scholar
- 18.Sousa P, Providência R, Albenque J, Khoueiry Z, Combes N, Combes S, et al. Impact of free thyroxine on the outcomes of left atrial ablation procedures. Am J Cardiol. 2015;116(12):1863–8.Google Scholar
- 19.Tang R, Liu D, Dong J, Liu X, Long D, Yu R, et al. High-normal thyroid function and risk of recurrence of atrial fibrillation after catheter ablation. Circ J. 2010;74(7):1316–21.Google Scholar
- 20.Dart C. Lipid microdomains and the regulation of ion channel function. J Physiol. 2010;588(Pt 17):3169–78.Google Scholar
- 21.Kim S, Kim J, Shin D, Kim J, Cho K. Relation of atrial fibrillation (AF) and change of lipoproteins: male patients with AF exhibited severe pro-inflammatory and pro-atherogenic properties in lipoproteins. Clin Biochem. 2014;47(10–11):869–75.Google Scholar
- 22.Kimura T, Takatsuki S, Inagawa K, Katsumata Y, Nishiyama T, Nishiyama N, et al. Serum inflammation markers predicting successful initial catheter ablation for atrial fibrillation. Heart Lung Circ. 2014;23(7):636–43.Google Scholar
- 23.Lew J, Sanghavi M, Ayers C, McGuire D, Omland T, Atzler D, et al. Sex-based differences in cardiometabolic biomarkers. Circulation. 2017;135(6):544–55.Google Scholar
- 24.Tse H, Oral H, Pelosi F, Knight B, Strickberger S, Morady F. Effect of gender on atrial electrophysiologic changes induced by rapid atrial pacing and elevation of atrial pressure. J Cardiovasc Electrophysiol. 2001;12(9):986–9.Google Scholar
- 25.Watanabe H, Tanabe N, Yagihara N, Watanabe T, Aizawa Y, Kodama M. Association between lipid profile and risk of atrial fibrillation. Circ J. 2011;75(12):2767–74.Google Scholar
- 26.Folsom AR, Pankow JS, Tracy RP, Arnett DK, Peacock JM, Hong Y, et al. Association of C-reactive protein with markers of prevalent atherosclerotic disease. Am J Cardiol. 2001;88(2):112–7.Google Scholar