Insulin resistance, left atrium enlargement, and recurrence in patients with atrial fibrillation undergoing radiofrequency ablation

Aims: To investigate the association between insulin resistance (IR), left atrial enlargement, and atrial fibrillation (AF) recurrence in AF patients undergoing radiofrequency catheter ablation (RFCA). Methods: 910 AF patients were evaluated for IR using TyG-BMI and left atrial enlargement using LAD. Various analytical methods were employed to study the relationship between TyG-BMI, LAD, and AF recurrence. Results: Over a median 12-month follow-up period, 189 (20.77%) cases of AF recurrence were observed. The likelihood of AF recurrence rose with elevated TyG-BMI and LAD levels. After adjusting for multiple factors, both TyG-BMI and LAD were significant predictors of AF recurrence. Both TyG-BMI and LAD demonstrated a positive dose-response relationship with AF recurrence. The areas under the ROC curves for TyG-BMI and LAD in predicting AF recurrence were 0.634 and 0.639, respectively. Notably, LAD partly mediated the association between TyG-BMI and AF recurrence, accounting for an 19.23% proportion. Conclusion: Elevated baseline TyG-BMI and LAD were associated with a higher risk of AF recurrence in patients undergoing RFCA. Furthermore, the enlargement of the left atrium partially mediated the relationship between IR and AF recurrence. Ameliorating IR may serve as a potential upstream therapy for the comprehensive management of AF in clinical practice.