Catheter ablation of atrial fibrillation in patients with diabetes mellitus

• Published in: Heart rhythm O2 Vol. 1; no. 3; pp. 180 - 188
• Main Authors: Wang, Allen, Truong, Tracy, Black-Maier, Eric, Green, Cynthia, Campbell, Kristen B., Barnett, Adam S., Febre, Janice, Loring, Zak, Al-Khatib, Sana M., Atwater, Brett D., Daubert, James P., Frazier-Mills, Camille, Hegland, Donald D., Jackson, Kevin P., Jackson, Larry R., Koontz, Jason I., Lewis, Robert K., Pokorney, Sean D., Sun, Albert Y., Thomas, Kevin L., Bahnson, Tristam D., Piccini, Jonathan P.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2020; Elsevier
• Subjects: Atrial fibrillation; Catheter ablation; Clinical; Diabetes mellitus; Glycemic control; Outcomes; Glycemic control; Atrial fibrillation; Catheter ablation; Diabetes mellitus; Outcomes
• ISSN: 2666-5018; 2666-5018
• DOI: 10.1016/j.hroo.2020.04.006

Diabetes mellitus (DM) is an independent risk factor for atrial fibrillation (AF). Few studies have compared clinical outcomes after catheter ablation between patients with and those without DM. The purpose of this study was to compare AF ablation outcomes in patients with and those without DM. We performed a retrospective analysis of 351 consecutive patients who underwent first-time AF ablation. Clinical outcomes included freedom from recurrent atrial arrhythmia, symptom burden (Mayo AF Symptom Inventory score), cardiovascular and all-cause hospitalizations, and periprocedural complications. Patients with DM (n = 65) were older, had a higher body mass index, more persistent AF, more hypertension, and larger left atrial diameter (P <.05 for all). Median (Q1, Q3) total radiofrequency duration [64.0 (43.6, 81.4) minutes vs 54.3 (39.2, 76.4) minutes; P = .132] and periprocedural complications (P = .868) did not differ between patients with and those without DM. After a median follow-up of 29.5 months, arrhythmia recurrence was significantly higher in the DM group compared to the no-DM group after adjustment for baseline differences (adjusted hazard ratio [HR] 2.24; 95% confidence [CI] 1.42–3.55; P = .001). There was a nonsignificant trend toward higher AF recurrence with worse glycemic levels (HR 1.29; 95% CI 0.99–1.69; P = .064). Although safety outcomes associated with AF ablation were similar between patients with and those without DM, arrhythmia-free survival was significantly lower among patients with DM. Poor glycemic control seems to an important risk factor for AF recurrence.