Impact of Metabolic Syndrome on Left Atrial Electro-Anatomical Remodeling and Outcomes after Radiofrequency Ablation of Non Valvular 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.
Method and Results—We performed pulmonary vein isolation and voltage mapping in two hundred thirty-six AF patients (age 61±9.6 y.; persistent AF 64%, MetS 54%). LA low-voltage (LoVo) areas were semiquantitatively estimated and presented as LoVo index. MetS was defined according to NCEP ATP III Panel. Follow-up for AF recurrence up to 12 months was performed. LA low-voltage areas were observed in 46% of MetS vs. 8.2% in non-MetS patients; p < 0.0001. MetS was an independent predictor for LA low-voltage areas: OR 11.64; 95% CI (4.381 - 30.903); p < 0.0001. Observed AF recurrence at 12-months was 42.7% in MetS vs. 36.1 % in non-MetS group (p=0.303). Presence of LA low-voltage areas was a predictor for 12-months AF recurrence: OR 2.99; 95% CI (1.36 - 6.56), p = 0.006. Probability for 12-months AF recurrence increased with 84.5% for every unit of LoVo Index.
Conclusions—MetS was not associated with worse outcomes after radiofrequency ablation (RFCA) of atrial fibrillation, 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.
- Received October 21, 2013.
- Revision received April 4, 2014.
- Accepted April 10, 2014.