Variant rs2200733 and rs10033464 on chromosome 4q25 are associated with increased risk of atrial fibrillation after catheter ablation: Evidence from a meta-analysis

Background: Common genetic polymorphisms at chromosome 4q25 were associated with increased susceptibility to atrial fibrillation (AF). However, it remained controversial whether these variants could be used as risk predictors for AF recurrence after catheter ablation. We therefore performed a metaanalysis to quantify the association between rs2200733 C>T/rs10033464 G>T and AF recurrence. Methods: Relevant studies were systematically retrieved from PubMed, Web of Science, Elsevier database and Cochrane library through November 2016. Data were abstracted and pooled using Stata 12.0 software. Results: A total of 2,145 patients undergoing catheter ablation were included. Patients with rs2200733 TT or TT+CT showed an overall increased susceptibility to AF recurrence (homozygous model [TT vs. CC]: odds ratio [OR] = 2.03, 95% confidence interval [CI] 1.49–2.76, p = 0.000; dominant model [TT+TC vs. CC]: OR = 1.48, 95% CI 1.17–1.87, p = 0.001; recessive model [TT vs. TC+CC]: OR = 1.88, 95% CI 1.12–3.15, p = 0.017). Subgroup analysis also identified a positive relation in Caucasians and late recurrence of AF in allelic, homozygous and dominant comparison. Moreover, a significant increased risk of AF recurrence was observed in patients with rs10033464 TG or TT+TG (heterozygous model [TG vs. GG]: OR = 1.46, 95% CI 1.01–2.12, p = 0.047; dominant model [TT+TG vs. GG]: OR = 1.51, 95% CI 1.04–2.17, p = 0.029). Conclusions: After catheter ablation, rs2200733 (TT or TT+TC) and rs10033464 (TT+TG or TG) were associated with increased risk of AF recurrence

Effectiveness of early rhythm control in improving clinical outcomes in patients with atrial fibrillation:a systematic review and meta-analysis

BackgroundCurrent guidelines recommend rhythm control for improving symptoms and quality of life in symptomatic patients with atrial fibrillation (AF). However, the long-term prognostic outcomes of rhythm control compared with rate control are still inconclusive. In this meta-analysis, we aimed to assess the effects of early rhythm control compared with rate control on clinical outcomes in newly diagnosed AF patients.MethodsWe systematically searched the PubMed and Embase databases up to August 2022 for randomized and observational studies reporting the associations of early rhythm control (defined as within 12 months of AF diagnosis) with effectiveness outcomes. The primary outcome was a composite of death, stroke, admission to hospital for heart failure (HF), or acute coronary syndrome (ACS). Hazard ratios (HRs) and 95% confidence intervals (CIs) from each study were pooled using a random-effects model, complemented with an inverse variance heterogeneity or quality effects model.ResultsA total of 8 studies involving 447,202 AF patients were included, and 23.5% of participants underwent an early rhythm-control therapy. In the pooled analysis using the random-effects model, compared with rate control, the early rhythm-control strategy was significantly associated with reductions in the primary composite outcome (HR = 0.88, 95% CI: 0.86-0.89) and secondary outcomes, including stroke or systemic embolism (HR = 0.78, 95% CI: 0.71-0.85), ischemic stroke (HR = 0.81, 95% CI: 0.69-0.94), cardiovascular death (HR = 0.83, 95% CI: 0.70-0.99), HF hospitalization (HR = 0.90, 95% CI: 0.88-0.92), and ACS (HR = 0.86, 95% CI: 0.76-0.98). Reanalyses using the inverse variance heterogeneity or quality effects model yielded similar results.ConclusionsOur current meta-analysis suggested that early initiation of rhythm control treatment was associated with improved adverse effectiveness outcomes in patients who had been diagnosed with AF within 1 year.RegistrationThe study protocol was registered to PROSPERO (CRD42021295405)

Association between weight loss and outcomes in patients undergoing atrial fibrillation ablation: a systematic review and dose–response meta-analysis

Abstract Background Obesity is an strong risk factor for atrial fibrillation (AF), and obesity can affect the prognosis of AF. However, the role of weight loss on outcomes after ablation remains unclear. Objectives This study aims to determine the relationship between weight loss and outcomes in patients with AF ablation, as well as the potential dose–response relationship. Methods The Cochrane Library, PubMed, and Embase databases were searched to identify studies that reported a relationship between weight loss and ablation up to August 17, 2021. Relative risks (RRs) were pooled using random-effects models. Results One randomized, open-labeled clinical trial and seven cohort studies involving 1283 patients were included. The mean body mass index of all included studies was over 30 kg/m2. The clinical trial showed a non-significant benefit of weight loss intervention on AF recurrence (Odd risk [OR] = 1.02, 95% confidence interval [CI] 0.70–1.47). Meta-analysis based on observational studies showed that the recurrence rate of AF after ablation was significantly reduced (RR = 0.43, 95% CI 0.22–0.81, I2 = 97%) in relatively obese patients with weight loss compared with the control group. Each 10% reduction in weight was associated with a decreased risk of AF recurrence after ablation (RR = 0.54, 95% CI 0.33–0.88) with high statistical heterogeneity (I2 = 76%). An inverse linear association (Pnon-linearity = 0.27) between AF relapse and increasing weight loss was found. Conclusions Our results first suggest an inverse dose–response association between weight loss and risk of recurrent AF after ablation, with moderate certainty. Graphical Abstrac