HbA1c levels as predictors of ablation outcome in type 2 diabetes mellitus and paroxysmal atrial fibrillation

Lu, Zhenyu; Liu, N.; Bai, Rong; Yao, Yan; Li, S.-N.; Yu, Rong‐Hui; Sang, Caihua; Tang, Ri‐Bo; Long, Deyong; Du, Xin; Dong, Jianzeng; Ma, Changsheng

doi:10.1007/s00059-014-4154-6

Cited by 36 publications

(25 citation statements)

References 26 publications

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“…Of the 14 selected studies, 3 studies [4,9,13] reported that higher HbA1c levels increase the risk of AF, 3 studies [7,8,14] demonstrated that higher HbA1c levels are a protective factor for AF, and the remaining eight studies [5,6,11,15–19] showed no significant association between HbA1c levels and AF.…”

Section: Resultsmentioning

confidence: 99%

Serum glycated hemoglobin level as a predictor of atrial fibrillation: A systematic review with meta-analysis and meta-regression

Zhang

Korantzopoulos

et al. 2017

PLoS ONE

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Background and AimGlycated hemoglobin (HbA1c) is a long-term measure of glucose control. Although recent studies demonstrated a potential association between HbA1c levels and the risk of atrial fibrillation (AF), the results have been inconsistent. The aim of this meta-analysis is to evaluate the utility of HbA1c level in predicting AF.MethodsPubMed and the Cochrane Library databases were searched for relevant studies up to March 2016. Prospective cohort studies and retrospective case-control studies were included. Relative risk (RR) or odds ratio (OR) with 95% confidence intervals (CIs) of AF development were determined for different HbA1c levels. The random effect model was conducted according to the test of heterogeneity among studies. Subgroup analyses and meta-regression models were carried out to identify potential sources of heterogeneity.ResultsEight prospective cohort studies with 102,006 participants and 6 retrospective case-control studies with 57,669 patients were finally included in the meta-analysis. In the primary meta-analysis, HbA1c levels were not associated with an increased risk of AF whether as a continuous (RR, 1.06; 95% CI, 0.96–1.18) or categorical variable (RR, 0.99; 95% CI, 0.83–1.18). Nevertheless, prospective studies showed about 10% increased risk of AF with elevated HbA1c levels both as a continuous (RR, 1.11; 95% CI, 1.06–1.16) and as a categorical variable (RR, 1.09; 95% CI, 1.00–1.18). In subgroup analyses, pooled results from studies with longer follow-up durations, published after 2012, aged < 63 years, with exclusion of cardiac surgery patients demonstrated an increased risk of AF for every 1% increase in HbA1c levels, while studies conducted in the United States with longer follow-up (more than 96 months), larger sample size and higher quality score (≥6) showed an increased risk of AF for higher HbA1c level as a categorical variable.ConclusionsElevated serum HbA1c levels may be associated with an increased risk of AF, but further data are needed. Serum HbA1c levels might be considered as a potential biomarker for prediction of AF.

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Section: Resultsmentioning

confidence: 99%

Serum glycated hemoglobin level as a predictor of atrial fibrillation: A systematic review with meta-analysis and meta-regression

Zhang

Korantzopoulos

et al. 2017

PLoS ONE

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“…Nevertheless, it is known that the LA and LV in patients with these two metabolic disorders are typically affected by extensive fibrosis; this fibrosis also represents a cardinal feature of both HFpEF and longstanding AF . Unfortunately, patients with AF who have myocardial fibrosis are unlikely to maintain sinus rhythm following an ablation procedure; this is likely to explain the high rate of AF recurrence following catheter ablation in patients with obesity or type 2 diabetes …”

Section: Therapeutic Challenges In Patients With a Metabolic Disordermentioning

confidence: 99%

“…Among patients with AF who undergo ablation, those who have increased LA dimensions, pressures or fibrosis, or LV fibrosis or abnormal diastolic filling parameters are at increased risk for AF recurrence and often require repeated ablation procedures; in patients without a prior myocardial infarction (i.e. HFpEF), the finding of ventricular fibrosis doubles the procedural failure rate .…”

Section: Therapeutic Challenges In Patients With a Metabolic Disordermentioning

confidence: 99%

Do most patients with obesity or type 2 diabetes, and atrial fibrillation, also have undiagnosed heart failure? A critical conceptual framework for understanding mechanisms and improving diagnosis and treatment

Packer

2019

European J of Heart Fail

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Obesity and diabetes can lead to heart failure with preserved ejection fraction (HFpEF), potentially because they both cause expansion and inflammation of epicardial adipose tissue and thus lead to microvascular dysfunction and fibrosis of the underlying left ventricle. The same process also causes an atrial myopathy, which is clinically evident as atrial fibrillation (AF); thus, AF may be the first manifestation of HFpEF. Many patients with apparently isolated AF have latent HFpEF or subsequently develop HFpEF. Most patients with obesity or diabetes who have AF and exercise intolerance have increased left atrial pressures at rest or during exercise, even in the absence of diagnosed HFpEF. Among patients with AF, those who also have latent HFpEF have increased risk for systemic thromboembolism and death. The identification of HFpEF in patients with obesity or diabetes alters the risk‐to‐benefit relationship of commonly prescribed treatments. Bariatric surgery and statins can ameliorate AF and reduce the risk for HFpEF. Conversely, antihyperglycaemic drugs that promote adipogenesis or cause sodium retention (insulin and thiazolidinediones) may increase the risk for heart failure in patients with an underlying ventricular myopathy. Patients with obesity and diabetes who undergo catheter ablation for AF are at increased risk for AF recurrence and for post‐ablation increases in pulmonary venous pressures and worsening heart failure, especially if HFpEF coexists. Therefore, AF may be the earliest indicator of HFpEF in patients with obesity or type 2 diabetes, and recognition of HFpEF alters the management of these patients.

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“…Similarly, biomarkers of an underlying HFpEF (ie, abnormalities of LV diastolic filling or left atrial geometry) identify patients who are unlikely to achieve and sustain sinus rhythm, whether the AF is treated electrically or pharmacologically . Additionally, both obesity and diabetes are accompanied by a high rate of AF recurrence following catheter ablation . Procedural success following ablation is diminished by LA fibrosis, which is a common finding in both metabolic disorders, especially if the AF is long‐standing or is accompanied by latent HFpEF …”

Section: Heightened Risks Of Rate‐control Strategies For Af In Obesitmentioning

confidence: 99%

“…[54][55][56] Additionally, both obesity and diabetes are accompanied by a high rate of AF recurrence following catheter ablation. 57,58 Procedural success following ablation is diminished by LA fibrosis, which is a common finding in both metabolic disorders, especially if the AF is long-standing or is accompanied by latent HFpEF. 59,60…”

Section: Heightened Risks Of Rate-control Strategies For Af In Obesmentioning

confidence: 99%

Heightened risk of intensive rate control in patients with atrial fibrillation who are obese or have type 2 diabetes: A critical review and re‐evaluation

Packer

2019

Cardiovasc electrophysiol

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Atrial fibrillation (AF) is common in patients with obesity and diabetes; the arrhythmia (if long‐standing) is typically managed by rate control and anticoagulation. However, the coexistence of these two metabolic disorders complicates therapeutic options for rate control. The likely pathogenesis of AF in these patients is an expansion of epicardial adipose tissue whose inflammation is transmitted to the left atrium causing electromechanical remodeling. However, this same process is also transmitted to the left ventricle (LV), impairing its distensibility and its ability to tolerate volume, leading to heart failure with preserved ejection fraction. Unfortunately, the latter diagnosis (although commonly present in patients with AF and a coexistent metabolic disorder) is often ignored. To achieve rate control, physicians prescribe intensive treatment with atrioventricular (AV) nodal–blocking drugs, often at doses that are titrated to blunt exercise as well as resting heart rate responses. However, strict rate control (target rate, <80/min) is associated with somewhat worse outcomes than lenient rate control (target rate, <110/min). Furthermore, any rate slowing that facilitates diastolic filling may aggravate filling pressures that are already disproportionately increased because the LV is stiff and overfilled as a result of cardiac inflammation. Rate slowing in AF with beta blockers may not achieve the benefit expected from the blockade of adrenergically mediated cardiotoxicity, and some AV nodal–blocking drugs (digoxin and dronedarone) can increase the risk of death in patients with AF. Finally, cardiac fibrosis in obesity and diabetes may affect the conduction system, which can predispose to serious bradyarrhythmias if patients are prescribed AV nodal–blocking drugs.

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HbA1c levels as predictors of ablation outcome in type 2 diabetes mellitus and paroxysmal atrial fibrillation

Abstract: High levels of HbA1c were associated with an increased risk of recurrence of atrial tachyarrhythmia in patients with T2DM and PAF undergoing catheter ablation.

Cited by 36 publications

References 26 publications

Serum glycated hemoglobin level as a predictor of atrial fibrillation: A systematic review with meta-analysis and meta-regression

Serum glycated hemoglobin level as a predictor of atrial fibrillation: A systematic review with meta-analysis and meta-regression

Do most patients with obesity or type 2 diabetes, and atrial fibrillation, also have undiagnosed heart failure? A critical conceptual framework for understanding mechanisms and improving diagnosis and treatment

Heightened risk of intensive rate control in patients with atrial fibrillation who are obese or have type 2 diabetes: A critical review and re‐evaluation

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