Abstract 241: Are Patients With Metabolic Syndrome or Its Components at Higher Risk of Atrial Fibrillation Recurrence After Catheter Ablation? A Meta-analysis.

Abstract

Objective: Metabolic syndrome (MetS) has been associated with incidence of atrial fibrillation (AF), but its impact on recurrence of AF after catheter ablation is unclear. We conduct a meta-analysis to summarize the relative risks (RR) of AF recurrence after catheter ablation in patients with versus (vs.) without MetS or its components, including obesity, hypertension, diabetes, and dyslipidemia. Methods: Among 666 articles identified from PubMed, EMBASE, and Cochrane Central Register of Controlled Trials, we included 21 studies with a total of 10726 patients (6739 with paroxysmal AF and 3987 with non-paroxysmal AF) for analysis. Variables assessed included: study years/size/design/population characteristics, including mean left atrial diameter, left ventricular ejection fraction and AF duration, AF ablation methods, blanking period, use of anti-arrhythmic drugs, AF recurrence ascertainment methods, variables adjusted in the original analysis, and other quality indicators. RRs were synthesized by random-effects models. Results: Our meta-analysis found an elevated risk of AF recurrence after ablation in patients with vs. without MetS (RR: 2.27, 95 % confidence interval [CI]: 1.35–3.80). Among the components of metabolic syndrome, the risk of AF recurrence was higher in patients with hypertension (RR: 1.36, 95 %CI: 1.13–1.62) but not in those with diabetes (RR: 1.23, 95 % CI: 0.92–1.66), or dyslipidemia (RR: 1.12, 95 % CI: 0.77–1.65). There was a non-significant trend suggesting a positive association between obesity and AF recurrence (RR: 1.77, 95% CI: 0.90–3.48) when body mass index (BMI) was evaluated as a categorical variable (BMI>25) but not as a continuous variable (RR: 1.00, 95% CI: 0.94–1.07). Vast majority of the studies assessed any AF recurrence after blanking period (2-3 months). Only 2 studies specifically addressed very late recurrence (>1 year) and they found higher AF recurrence in those with hypertension and dyslipidemia. Conclusion: Metabolic syndrome may be associated with a 2-fold increased risk of AF recurrence after catheter ablation. Hypertension appears to play a more important role in this association. The results regarding BMI and AF recurrence were heterogeneous but the relationship is likely non-linear. Further studies are warranted to evaluate the impact of modification of these factors on the risk of AF recurrence.