Impact of metabolic syndrome on left atrial electroanatomical remodeling and outcomes after radiofrequency ablation of nonvalvular atrial fibrillation.
BACKGROUND
Recent studies reported worse outcomes after atrial fibrillation (AF) ablation in patients with metabolic syndrome (MetS). However, mechanisms of AF recurrence in MetS remain unclear.


RESULTS
We performed pulmonary vein isolation and voltage mapping in 236 patients with AF (age 61±9.6 years; persistent AF 64%; MetS 54%). Left atrial (LA) low voltage areas were semiquantitatively estimated and presented as low voltage index. MetS was defined according to National Cholesterol Education Program Adult Treatment Panel III. Follow-up for AF recurrence ≤12 months was performed. LA low voltage areas were observed in 46% of patients with MetS versus 8.2% patients without MetS ; P<0.0001. MetS was an independent predictor of LA low voltage areas: odds ratio, 11.64; 95% confidence interval, 4.381-30.903; P<0.0001. Observed AF recurrence at 12 months was 42.7% in MetS versus 36.1% in the non-MetS group (P=0.303). The presence of LA low voltage areas was a predictor of 12-month AF recurrence: odds ratio, 2.99; 95% confidence interval, 1.36-6.56; P=0.006. Probability of 12-month AF recurrence increased with 84.5% for every unit of low voltage Index.


CONCLUSIONS
MetS was not associated with worse outcomes after radiofrequency catheter ablation of AF, but LA low voltage areas were more frequently observed in patients with MetS. The presence and extent of LA low voltage areas may influence the long-term outcomes after catheter ablation.
From the Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany. dinov@gmx.de.
Borislav
B
Dinov
From the Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
Jedrzej
J
Kosiuk
From the Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
Simon
S
Kircher
From the Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
Andreas
A
Bollmann
From the Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
Willem-Jan
WJ
Acou
From the Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
Arash
A
Arya
From the Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
Gerhard
G
Hindricks
From the Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
Sascha
S
Rolf
D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D064752:Atrial Remodeling; D001774:Blood Chemical Analysis; D018780:Body Surface Potential Mapping / Q000379:methods; D017115:Catheter Ablation / Q000379:methods* / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D013614:Tachycardia, Paroxysmal / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D016896:Treatment Outcome
atrial fibrillation