Atrial fibrillation (AF) is the most common arrhythmia worldwide, a major cause of heart failure and stroke, and carries a significant healthcare burden. Atrial cardiomyopathy (ACM) provides the structural and electrophysiological basis for AF, while metabolic dysregulation, particularly insulin resistance (IR), is increasingly recognized as a key factor exacerbating atrial remodeling. However, due to the complexity and high cost of IR measurement procedures, no reliable, user-friendly, and practical tool supporting AF risk stratification has yet been identified in clinical practice. To address this gap, we conducted a literature search in various databases and found an increasing body of research indicating that the triglyceride–glucose index (TyG index) is a simpler, more cost-effective alternative for identifying adverse metabolic profiles and the AF risk. This narrative review describes the existing literature and explores the potential mechanisms underlying changes in the TyG index and its clinical applications, while also discussing the challenges facing the use of this index and future research directions. In summary, the current evidence suggests that the TyG index is a promising but not yet established risk assessment biomarker for AF.

Background and objective: Evidence of percutaneous left atrial appendage closure (LAAC) and oral anticoagulants (OACs) in non-valvular atrial fibrillation (NVAF) patients with intermediate-to-borderline high stroke risk is scarce. We aimed to compare the efficacy and safety of these treatments in the latter clinical population. Methods: This retrospective cohort study included NVAF patients with CHA₂DS₂-VA scores of 1–2 and used 1:1 propensity score matching (184 patients per group) to compare efficacy and safety outcomes. The primary efficacy outcome was a composite of stroke, transient ischemic attacks, systemic embolism, and cardiovascular death during follow-up. Adverse safety events were categorized into peri-procedure (LAAC group) and non-procedural (both groups) events. Results: Over a mean follow-up of 48.93 ± 28.50 months, a total of 26 patients (7.07%) reached the primary composite efficacy endpoint. The LAAC group showed a significantly higher incidence of the efficacy endpoint compared to the OAC group (HR = 3.09; 95% CI 1.22–7.85; log-rank p = 0.01). Procedure-related events occurred in five LAAC patients (one contributing to primary endpoint), while non-procedural bleeding rates were similar (0.54% vs. 1.09%; p = 0.56). Subgroup analyses suggested concomitant ablation of NVAF in LAAC group did not significantly improve efficacy composite endpoints (HR = 0.47). Conclusions: In NVAF patients with intermediate-to-high stroke risk, OACs were more effective than LAAC in preventing thromboembolic events, with comparable rates of clinically relevant bleeding.