Effect of Insulin Resistance on Recurrence after Radiofrequency Catheter Ablation in Patients with Atrial Fibrillation

Abstract

BackgroundRecurrence after atrial brillation(AF) ablation has many risk factors. the relationship between the recurrence rate after ablation and IR in the non-diabetic patients with AF is not clear. MethodsRetrospective cohort study enrolled AF patients without diabetes who underwent ablation between 2018~2019 in the rst a liated hospital of zhengzhou university. Homeostasis model assessment of insulin resistance (HOMA-IR) was calculated and a value of ≥2.69 was de ned as insulin resistant(IR). The patients were categaried into two groups: those with HOMA-IR<2.69 in group 1(n=163); HOMA-IR≥2.69 in group 2 (n=69). Multivariable adjusted Cox proportional hazard models were performed to compare the risk of AF recurrence after ablation. The de nition of AF recurrence was documented AF, atrial utter, or atrial tachycardia lasting >30 seconds recorded in ECG or 24-hour Holter monitoring after 3 months blanking period. Results232 AF patients receiving ablation were enrolled and the median age was 59.5±11.3 years . There were 166 cases of paroxysmal AF and 66 cases of persistent AF. Patients with IR (n=69)were more likely to have Dyslipidemia, higher fasting blood glucose and fasting insulin than those in non-IR group. Patients with IR also were more likely to recieve antiarrhythmic drugs before ablation. After a mean follow-up of 322±85 days, 62(26.7%) patients had documented recurrence of AF. Multivariable analysis showed that HOMA-IR value and left atrial diameter LAD were independent risk factors for recurrence after AF ablation (HR: 1.

The pre-ablation triglyceride-glucose index predicts late recurrence of atrial fibrillation after radiofrequency ablation in non-diabetic adults

“…IR refers to the inability of peripheral tissues to correctly use endogenous insulin for maintaining glucose homeostasis in the body [ 15 , 16 ]. IR is associated with LA remodeling and AF development, even before diabetes [ 17 , 18 , 20 ]. IR may predispose patients to AF progression by increasing LA size or impairing left ventricular diastolic function [ 18 , 20 , 21 ].…”

“…In an animal mode of IR, IR was associated with various aspects of LA remodeling, including increased oxidative stress injury [ 24 ], elevated expression of hyperphosphorylated calcium related proteins, and atrial interstitial fibrosis [ 22 – 24 ]. IR promotes LA structural remodeling and abnormal intracellular calcium homeostasis [ 18 ], resulting in increased susceptibility to AF [ 17 ]. Increased oxidative stress and inflammation can lead to IR and impaired insulin secretion [ 24 ].…”

“…Inflammation, IR, and oxidative stress injury are linked to one another and, consequently, result in atrial electrical remodeling [ 18 , 24 ], LA fibrosis [ 18 ], and LA low-voltage areas(LVAs) [ 25 ], which are likely the main constituents of AF pathophysiology [ 25 , 26 ]. Most components of IR, such as glucose tolerance abnormalities, obesity and abnormal lipid levels, were found to have an additive effect on the risk of AF progression, which has been reported to be related to late recurrence of AF after RFCA [ 15 , 17 ].…”

“…Cardiometabolic risk factors such as dyslipidemia, hyperglycemia, central obesity, and hypertension, which are independent risk factors for CVDs, were independently associated with the TyG index [ 27 , 28 ]. Patients with cardiometabolic disorders or IR may be more susceptible to AF recurrence following RFCA [ 15 , 17 ]. To date, only a limited number of metabolic profiling studies investigating late AF recurrence have been performed.…”

“…IR is a pathological state in which cells or tissues cannot respond normally to insulin, and is characterized by increased body weight, hyperglycemia, dyslipidemia, and elevated blood pressure [ 15 , 16 ]. Cardiometabolic syndrome and IR are also common among non-diabetic patients and are associated with epicardial fat deposition and vulnerability to AF [ 12 , 17 , 18 ]. IR can induce AF by increasing left atrial (LA) volume or impairing left ventricular diastolic function [ 18 ].…”