Abstract 13807: Impact of Metabolic Syndrome on Left Atrial Remodelling and Outcomes After Radiofrequency Ablation for Atrial Fibrillation
Background: Recent study reported worse outcomes after ablation for atrial fibrillation (AF) in patients with metabolic syndrome (MetS). However, the mechanism of AF recurrence in MetS remains unclear. We suggested, that MetS through pro-inflammatory alterations, apoptosis, microvascular disease, induces extensive left atrial (LA) remodelling and associates with higher AF recurrence after ablation.
Objective: To investigate the impact of MetS on LA fibrosis and the outcomes after AF ablation.
Methods: two hundred thirty-eight AF patients (mean age 61±9.6 y.; persistent AF 64%, MetS 54%) were prospectively enrolled. Pulmonary vein isolation, LA voltage mapping and additional substrate-guided LA ablation were performed. LA fibrosis in each case was semi-quantitatively estimated on a scale 1-6 - scar index (SI). MetS was defined based on the NCEP ATP III Panel recommendations. Six months follow-up up for AF recurrence was performed.
Results: LA fibrosis was observed in 55% of cases with MetS versus 10% in non-MetS patients. The probability for LA fibrosis increases with a HR 7.16[3.06-16.74]; p < 0.0001 by presence of MetS. AF recurrence at 6th month was higher in LA fibrosis subgroup: 41% vs. 24%; p = 0.016. The probability for AF recurrence was higher in presence of LA scar: HR 3.13[1.46 - 6.68]; p = 0.003.
Conclusion: MetS associates with seven times greater probability for LA fibrosis. Patients with LA scar have three times greater risk for AF recurrence after ablation.
- © 2013 by American Heart Association, Inc.