Association between surrogate insulin resistance markers and postablation atrial fibrillation recurrence: A...

Atrial fibrillation (AF) is the most common persistent arrhythmia and demonstrates a notable recurrence rate after ablation. Previous studies have suggested that surrogate markers of insulin resistance could predict postablation AF recurrence. This systematic review and meta-analysis aimed to assess studies examining the relationship between surrogate insulin resistance markers and the recurrence of AF after ablation. We searched PubMed, Web of Science, Embase, and Scopus for observational studies published from inception to August 2024. We incorporated studies that assessed the relationship between surrogate insulin resistance markers and the occurrence of postablation AF in patients with either paroxysmal or persistent AF. The random-effects model was used for meta-analysis. The Newcastle-Ottawa scale was used to evaluate risk of bias, and the leave-one-out method was applied for sensitivity analysis (PROSPERO: CRD42024584526). Nine studies involving 7729 participants met the inclusion criteria. Significant associations with AF recurrence were observed for the triglyceride-glucose index (hazard ratio [HR] 1.29; 95% confidence interval [CI] 1.15-1.44; I² = 44%), homeostatic model assessment of insulin resistance (HR 1.27; 95% CI 1.14-1.42; I² = 0%), and metabolic score for insulin resistance (HR 1.04; 95% CI 1.03-1.05; I² = 0%). However, the triglyceride-to-high-density lipoprotein ratio did not demonstrate a statistically significant association with AF recurrence (HR 1.09; 95% CI 0.96-1.24; I² = 86%). Surrogate markers of insulin resistance can be valuable predictors for assessing the risk of AF recurrence in patients who have undergone catheter ablation, potentially aiding in preventive strategies. Nevertheless, further prospective studies are required to validate our findings.