The effect of non-insulin dependent insulin resistance indices on the prediction in the recurrence of late atrial fibrillation after modified maze procedure concomitant with valvular heart surgery.

OBJECTIVE

Surgical ablation of atrial fibrillation (AF) is suitable for patients with AF undergoing concomitant cardiac surgery. However, the high rate of AF recurrence after surgery remains a significant clinical concern. This study examined the association between insulin resistance (IR) indices and late AF recurrence in patients undergoing modified maze surgery combined with valvular heart surgery.

METHODS

A retrospective analysis was performed on 293 patients undergoing open-heart valve surgery and modified maze surgery. Patients were categorized into recurrence and non-recurrence groups based on atrial fibrillation recurrence beyond the 3-month postoperative window. Multivariate Cox proportional hazards regression and restricted cubic spline (RCS) analyses were employed to assess the association between insulin resistance indices and late AF recurrence. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive ability of insulin resistance indices for late AF recurrence.

RESULTS

A total of 293 patients were enrolled (131 males, 162 females). During a median follow-up of 25.00 months, 88 patients (30.03%) experienced late AF recurrence. Compared to the non-recurrence group, patients with recurrence had significantly higher baseline preoperative IR indices. Multivariate Cox regression identified recurrence during postoperative hospitalization, left atrial diameter (LAD), and IR indices were risk factors for late AF recurrence of postoperative. Multivariate adjusted RCS curves demonstrated a linear correlation between IR indices and late AF recurrence.

CONCLUSION

IR indices demonstrated statistically significant but clinically modest associations with late AF recurrence in patients undergoing concomitant cardiac valve and modified maze surgery.