Abstract
The relationship between serum homocysteine (Hcy) levels and atrial fibrillation
(AF) recurrence following catheter ablation remains unclear. This meta-analysis
aims to investigate this association. Comprehensive searches in PubMed, Web of
Science, Embase, Wanfang, and China National Knowledge Infrastructure (CNKI)
databases identified relevant studies published up to May 25, 2024. Cohort
studies that measured pre-ablation serum Hcy levels and reported AF recurrence
post-ablation were included. Data were analyzed using random-effects models by
incorporating the potential influence of heterogeneity, with odds ratios (ORs)
and 95% confidence intervals (CIs) calculated for the association between serum
Hcy levels and AF recurrence. Eleven retrospective cohort studies involving 2147
patients with AF who underwent catheter ablation were analyzed. Higher
pre-ablation serum Hcy levels were associated with an increased risk of AF
recurrence (OR for per 1 μmol/l increment of Hcy: 1.22, 95% CI: 1.17 to 1.28,
p<0.001; I²=0%). Additionally, studies that categorized Hcy levels also found
a higher risk of AF recurrence in patients with elevated Hcy (OR for patients
with a high versus a low serum Hcy: 2.75, 95% CI: 2.02 to 3.75, p <0.001;
I²=0%). Funnel plots and Egger’s regression test indicated low risks of
publication bias. In conclusions, elevated pre-ablation serum Hcy levels are
significantly associated with an increased risk of AF recurrence post-catheter
ablation. These findings suggest that Hcy could be a valuable biomarker for
predicting AF recurrence and may inform pre-ablation risk stratification.
Further prospective studies are warranted to confirm these results.
Keywords
homocysteine - atrial fibrillation - catheter ablation - recurrence - meta-analysis
