Baseline lipid profile and recurrence of atrial arrhythmia after atrial fibrillation ablation: a multicenter study from the United States and Japan

Hyperlipidemia (HLD) is a modifiable cardiovascular risk factor and may influence atrial remodeling and arrhythmia recurrence following atrial fibrillation (AF) ablation. However, the relationship between baseline lipid profile and post-ablation atrial arrhythmia (AA) recurrence remains unclear. We retrospectively examined patients who underwent AF ablation at two tertiary care centers in the U.S. and Japan. Patients with a lipid profile obtained within 24 months prior to AF ablation and a one-year post-ablation follow-up were included. AA recurrence was defined as having a 12-lead electrocardiogram, or a Holter monitor or device recording of AF or atrial tachycardia lasting at least 30 seconds. This was assessed after the 3-month blanking period through 12 months after ablation. Multivariable logistic regression was performed to examine the association of lipid profiles with AA recurrence. To address concerns about overfitting, a parsimonious model was constructed that limit covariates based on clinical relevance and established associations with AA recurrence. Among 285 patients (mean age (standard deviation), 63.6 (10.5) years, 64% male), 52 patients (18.2%) had documented AA recurrence between the end of the 3-month blanking period and 12 months after ablation. Patients with low-density lipoprotein (LDL) <70 mg/dL or total cholesterol <141 mg/dL had lower odds of AA recurrence in unadjusted analysis. These associations remained significant after adjustment for age, sex, BMI, race (white vs others), institution, statin use, current smoking, alcohol use, traditional AF risk factors (hypertension, diabetes mellitus type 2, chronic kidney disease, heart failure, obstructive sleep apnea), type of AF (paroxysmal AF, persistent AF, and long-standing persistent AF), beta-blocker use, calcium channel blocker use, digoxin use, and antiarrhythmic drug use (odds ratios [95% confidence intervals]: 0.26 [0.08 – 0.85] and 0.24 [0.07 – 0.82], respectively). These findings were consistent in the parsimonious model. In this international registry, lower baseline LDL and total cholesterol levels were associated with reduced odds of AA recurrence. Prospective studies are warranted to confirm these findings and clarify the underlying mechanisms.