Comparison of outcome in catheter ablation of atrial fibrillation in patients with versus without the metabolic syndrome.
Previous studies have reported that metabolic syndrome (MS) is associated with the development of atrial fibrillation (AF). However, its impact on the atrial substrate properties and catheter ablation in patients with AF is still unclear. This study consisted of 282 patients with AF (216 with paroxysmal AF and 66 with nonparoxysmal AF) who underwent catheter ablation using a 3-dimensional mapping system (NavX). Detailed AF mapping (frequency analysis and complex fractionated electrographic mapping) was performed in 59 patients. The patients were classified on the basis of MS, which was defined according to the guidelines of the National Cholesterol Education Program Adult Treatment Panel III. Patients with MS had larger left atrial sizes, shorter fractionated intervals, and higher dominant frequencies compared with those without it. Higher incidences of complex fractionated atrial electrographic sites located in the left atrial appendage base, coronary sinus, and crista terminalis regions were found in patients with MS. Patients with MS had a higher incidence of recurrent AF compared with those without MS (55% vs 24%, p <0.001). A higher incidence of recurrent AF from non-pulmonary vein origins was observed in patients with MS compared with those without it (45% vs 20%, p = 0.037). In conclusion, MS is associated with larger left atrial size and an arrhythmogenic substrate, which may increase the risk for recurrence after the ablation of AF. Close follow-up with good control of any metabolic disturbances may be needed in patients with MS to improve their outcomes after AF ablation.
Chang
Shih-Lin
SL
Department of Medicine and Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan.
Tuan
Ta-Chuan
TC
Tai
Ching-Tai
CT
Lin
Yenn-Jiang
YJ
Lo
Li-Wei
LW
Hu
Yu-Feng
YF
Tsao
Hsuan-Ming
HM
Chang
Chien-Jun
CJ
Tsai
Wen-Chin
WC
Chen
Shih-Ann
SA
D001281:Atrial Fibrillation / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000503:physiopathology*; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D015994:Incidence; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications*; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D012307:Risk Factors; D016896:Treatment Outcome