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Background  Hypothyroidism has been shown to contribute to enhanced atrial arrhythmogenesis, resulting in atrial fibrillation ( AF ) development in animal models and clinical populations. We aimed to elucidate whether high thyroid‐stimulating hormone ( TSH ) levels are related to outcomes of catheter ablation of  AF .    Methods and Results  Of 477 consecutive patients who underwent first‐time pulmonary vein isolation–based radiofrequency catheter ablation of  AF , 456 with  TSH  above the lower limit of the normal range (age, 65.5±9.9 years; men, 73.9%; paroxysmal  AF , 56.8%) were analyzed for this study. Atrial tachyarrhythmia recurrence for 3 years was compared across groups with hypothyroidism (n=23) and  TSH  quartile groups with euthyroidism (normal‐range  TSH  levels, n=433). Atrial tachyarrhythmia recurrence occurred in 179 patients (39%) after the first session. Patients with hypothyroidism had increased recurrence compared with patients with normal  TSH  levels (crude hazard ratio, 3.14 after the last session;  P =0.001). When focusing on patients with normal  TSH  levels, recurrence‐free survivals after both the first and last sessions were significantly reduced in euthyroid patients with the highest quartile of  TSH  levels (quartile 4) compared with others (quartiles 1–3). Cox regression analysis identified high  TSH  levels as an independent predictor of atrial tachyarrhythmia recurrence after both the first (adjusted hazard ratio, 1.51;  P =0.018) and last (adjusted hazard ratio, 1.86;  P =0.023) sessions. The difference was more pronounced in patients with paroxysmal  AF  than in those with nonparoxysmal  AF .    Conclusions  Not only hypothyroidism but also high‐normal  TSH  levels may be an independent predictor of atrial tachyarrhythmia recurrence after catheter ablation of  AF .

High‐Normal Thyroid‐Stimulating Hormone Shows a Potential Causal Association With Arrhythmia Recurrence After Catheter Ablation of Atrial Fibrillation