Risk Factors for Failure of Direct Current Cardioversion in Patients with Type 2 Diabetes Mellitus and Atrial Fibrillation

Abstract

Introduction Type 2 diabetes mellitus (T2DM) is a well-recognised risk factor for cardiovascular disease and the prevalence of atrial fibrillation (AF) is higher among patients with T2DM. Direct current cardioversion (DCCV) is an important management option in persistent AF. We sought to determine independent risk factors for immediate and short-term outcomes of DCCV for treatment of AF in patients with T2DM. Methods Retrospective outcome analysis of DCCV for persistent AF in 102 T2DM patients compared with 102 controls. Results DCCV was successful in 68 (66.6%) people with T2DM compared to 86 (84.3%) in the control group (P = 0.003). After initial successful cardioversion, only 38 (37.2%) T2DM patients remained in sinus rhythm compared to 63 (61.8%) in the control group (P = 0.007) at a median follow-up of 74.5 days (IQR 69.4–77.4). Multiple logistic regression analysis showed that the presence of T2DM (P = 0.014), digoxin use (P = 0.01), statin use (P = 0.005), left-atrial size (P = 0.01), and LV ejection fraction (P = 0.008) were independent risk factors for immediate DCCV failure. T2DM (P = 0.034) was an independent risk factor for AF relapse. Among patients with T2DM, previous DCCV (P = 0.033), digoxin use (P = 0.035), left-atrial size (P = 0.01), LV ejection fraction (P = 0.036), and HbA1c (P = 0.011) predicted immediate failure of DCCV whilst digoxin use (P = 0.026) was an independent risk factor for relapse of AF. Conclusion T2DM, higher HbA1c, digoxin treatment, and structural and functional cardiac abnormalities are independent risk factors for immediate DCCV failure and AF relapse.

Relationship of adverse events to quality of anticoagulation control in atrial fibrillation patients with diabetes: real-world data from the FANTASIIA Registry

“…prevalence of concomitant risk factors and other diseases (as expressed by higher Charlson index) could make physicians less prone to indicate cardioversion or ablation, given that the presence of one or more risk factors increases the risk of arrhythmia recurrence after ablation by 30% [28]. There is also a lower success rate of both cardioversion and subsequent maintenance of sinus rhythm in patients with DM [29], with a possible relationship to glycaemic control [30].…”

Arrhythmias and diabetes: atrial fibrillation

“…Direct current cardioversion was used to treat persistent AF and was successful in 66.6% of people with type 2 diabetes compared with 84.3% of people without diabetes. After successful cardioversion, only 37.5% of people with diabetes remained in sinus rhythm at about 10 weeks, compared with 61.8% of people without diabetes 14 …”

“…After successful cardioversion, only 37.5% of people with diabetes remained in sinus rhythm at about 10 weeks, compared with 61.8% of people without diabetes. 14 In a cohort study of 9749 people with atrial fibrillation, 29.5% had diabetes. Compared with those without diabetes, people with diabetes were younger, and more likely to have coronary heart disease, heart failure, hypertension, chronic kidney disease, stroke, and poorer quality of life.…”

Glycemic control and atrial fibrillation: an intricate relationship, yet under investigation

“…With regard to better ("B") AF-related symptom management, the presence of DM and/or increased HbA1c levels do not seem to affect the efficacy of pharmaceutical rate or rhythm control treatment strategies; yet electrical cardioversion and AF-ablation procedures seem to have higher rates of short-and long-term failure [109]. In the ABC pathway, the optimal management of comorbidities ("C") is of utmost importance to ameliorate the outcomes Incident AF occurred in 159 patients (1.58%) over the follow-up period at a rate of 5.9/1,000 person-years in the intensive-therapy group (targeting at HbA1c < 6.0%), and at a rate of 6.37/1,000 person-years in the standardtherapy group (targeting at 7% < HbA1c < 7.9%) (p = 0.52) Compared with patients with an HbA1c level of < 5.4%, the risk significantly increased when HbA1c levels were higher than 6.5%…”

“…With regard to better (“B”) AF-related symptom management, the presence of DM and/or increased HbA1c levels do not seem to affect the efficacy of pharmaceutical rate or rhythm control treatment strategies; yet electrical cardioversion and AF-ablation procedures seem to have higher rates of short- and long-term failure [ 109 ]. In the ABC pathway, the optimal management of comorbidities (“C”) is of utmost importance to ameliorate the outcomes of AF, and, therefore, DM requires optimal guideline-directed management [ 106 ].…”