Abstract 4342337: Cardiovascular, Kidney, and Metabolic (CKM) Syndrome is associated with increased risk for arrhythmia recurrence following atrial fibrillation (AF) ablation

Background: The concept of CKM syndrome reflects our evolving understanding that cardiovascular disease, including AF, is intricately connected to other systemic conditions. Objectives: To determine if the odds of AF recurrence following AF ablation changes with the presence of CKM syndrome and if odds are further modified in the presence of both kidney and metabolic components of CKM syndrome, compared to with the presence of only one. Methods: Patients from the Cleveland Clinic that underwent AF catheter ablation between 2013 and 2022 were included. CKM syndrome was defined as the presence of either metabolic disease or kidney disease in patients presenting for AF ablation. Metabolic disease was defined as the presence of BMI ≥ 25, HbA1c > 5.7%, hypertriglyceridemia (triglycerides ≥ 135 mg/dL), hypertension or diabetes. Kidney disease was defined as moderate-to-high-risk chronic kidney disease (eGFR < 60). The presence of AF, for which patients were undergoing ablation, was considered indicative of cardiovascular disease. AF recurrence was defined as recurrence within 1 year, following a 3-month blanking period. Statistical analyses were conducted using RStudio Pro (2023.09.0) Results: Of 7,020 patients undergoing AF ablation, 91.1% (6,397) had CKM syndrome. Presence of CKM syndrome increased arrhythmia recurrence by 19% (OR 1.19; CI 1.00–1.42; p=0.05), with a higher recurrence rate over time. Post-ablation LVEF was lower in patients with CKM syndrome (57.4±9.3 vs. 58.6±8.5; p=0.02), but this group showed a greater LVEF improvement (2.1% vs. 1.3%; p=0.03). Arrhythmia recurrence at 1 year was highest in those with CKM syndrome that had both kidney and metabolic disease (42.5% vs. 35.9%; p<0.01) with the shortest recurrence time. Conclusion: CKM syndrome is associated with increased odds of arrhythmia recurrence and shorter period of arrhythmia free survival post-AF ablation, particularly in patients with both renal and metabolic diseases.