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Observational Study
. 2024 Dec 28;24(1):750.
doi: 10.1186/s12872-024-04170-w.

Pre-procedural TMAO as a predictor for recurrence of atrial fibrillation after catheter ablation

Siyu Meng #  1 , Tianyi Ni #  1 , Qiuyao Du  1 , Mengjie Liu  1 , Peibing Ge  1 , Jin Geng  2 , Bingjian Wang  3
Affiliations
Observational Study

Pre-procedural TMAO as a predictor for recurrence of atrial fibrillation after catheter ablation

Siyu Meng et al. BMC Cardiovasc Disord. .

Abstract

Background: Numerous studies have demonstrated the significance of trimethylamine-N-oxide (TMAO) in the progression of atrial fibrillation (AF). However, the association between TMAO and AF recurrence (RAF) post-catheter ablation is not yet fully understood. This study aims to elucidate the predictive capability of pre-procedural TMAO levels in determining RAF following catheter ablation (CA).

Methods: This study was conducted as a prospective, single-center observational study. Between June 2021 and June 2022, 152 patients from the Department of Cardiology at The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University were enrolled. Baseline characteristics and serum TMAO levels were assessed for all participants. Patients with AF who underwent CA were monitored for recurrences of AF using electrocardiography (ECG) or 24-hour Holter monitoring during the follow-up period.

Results: The study found that serum TMAO levels were significantly higher in persistent AF (PeAF) patients compared to those in sinus rhythm (SR) and paroxysmal AF (PaAF) patients (3.96 ± 1.69 vs. 1.81 ± 0.59, 3.02 ± 1.50 µM, P < 0.001 and P < 0.01, respectively). After a one-year follow-up, 29 (21.2%) AF patients experienced recurrence after CA. Multivariate Cox proportional hazards regression analysis revealed that pre-procedural serum TMAO was an independent predictor of recurrent AF (HR = 1.78, 95% CI = 1.43-2.21, P < 0.001). The receiver operating characteristic (ROC) curve analysis identified a cut-off value of 4.3µM for serum TMAO levels in predicting recurrent AF (area under the curve: 0.835, P < 0.001). The Kaplan-Meier plot demonstrated that patients with TMAO levels greater than 4.3µM had a significantly higher rate of recurrent AF (HR = 13.53, 95% CI = 6.19-29.56, P < 0.001).

Conclusion: Patients with AF exhibited elevated levels of circulating TMAO compared to patients with SR. The findings suggest a potential role of TMAO in the development of AF, with pre-procedural serum TMAO levels serving as a reliable predictor of recurrence of AF CA.

Keywords: Atrial fibrillation recurrence; Catheter ablation; Predictor; TMAO.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by the ethics committee of Huai’an First People’s Hospital, and all patients involved signed informed consent. The methods used in this study were conducted in accordance with relevant guidelines and regulations. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Serum TMAO levels among groups. (A) TMAO levels between patients with sinus rhythm (SR), paroxysmal atrial fibrillation (PaAF), and persistent atrial fibrillation (PeAF). (B) TMAO levels between patients with atrial fibrillation recurrence (RAF) and without RAF (non-RAF). * Stands for P < 0.05, ** stands for P < 0.01 and *** stands for P < 0.001
Fig. 2
Fig. 2
Univariate and multivariate Cox analyzes of prognostic risk factors for RAF. (A) Forest plot of univariate cox regression analysis. (B) Forest plot of multivariate cox regression analysis. The vertical dashed line represents the reference line for an HR of 1
Fig. 3
Fig. 3
Serum TMAO ROC curve for predicting RAF
Fig. 4
Fig. 4
Kaplan–Meier (KM) survival curve for survival free from AF after atrial fibrillation ablation according to serum TMAO level. (A) The KM survival curve of PaAF. (B) The KM survival curve of PeAF. (C) The KM survival curve of all AF patients underwent ablation
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