The Effect of Diabetes Mellitus on the Recurrence of Atrial Fibrillation after Ablation

Abstract

Diabetes mellitus (DM) plays a crucial role in the regulation of atrial fibrillation (AF). This study aimed to evaluate the outcome of pulmonary vein isolation (PVI) using a single-shot device in patients with AF and DM. A total of 531 consecutive patients undergoing initial cryoballoon (CB)-guided PVI were evaluated. Two hundred eighty-one patients (53%) suffered from paroxysmal AF (PAF; mean age 51 ± 23.2 years, 26% female), 250 patients (48%) from persistent AF (PERS; 64 ± 10.0 years old, 30% female) and 80 patients (15%) were diagnosed with coincidental DM (68 ± 19.6 years old, 30% female). Follow-up visits were performed at 3, 6 and 12 months including 7-day Holter ECGs. Primary endpoint was the first documented recurrence of atrial tachyarrhythmia. AF recurrence occurred in 26% (140 patients). PAF patients with DM presented with a significantly higher risk for arrhythmia recurrence (Kaplan Meier analysis; Log rank p < 0.001 *). Multivariate analyses found DM to be an independent predictor (IP) for AF recurrence (p = 0.009 *, hazard ratio (HR) 4.363, confidence interval (CI) 1.456–13.074). In PERS, DM was associated with a 43% increase in AF recurrence (p = 0.320, HR 1.427, CI 0.707–2.879). DM has relevant effects on AF recurrence after PVI-only ablation approaches for AF. Major differences were observed in PAF as DM seems to favor the development of individual arrhythmia substrate, which is usually not yet present in PAF. In PERS, DM effects are less pronounced as individual fibrosis has already developed. Thus, personalized paths addressing individual arrhythmia substrates are needed in this specific cohort of patients.

The individual relationship between atrial fibrillation sources from CARTOFINDER mapping and atrial cardiomyopathy

“…1,4,5 Several studies point out the importance of LGE CMR imaging for the visualization of individual atrial fibrosis prior to the ablation procedure. [4][5][6][7] In our study, LGE CMR revealed an intermediate amount of 21.41% ± 6.32% of LA fibrosis consistent with Utah stages II-III. Importantly, no PERS AF patient was assigned to Utah stage I as all patients had more than 10% fibrosis of the LA.…”

News from the Cold Chamber: Clinical Experiences of POLARx versus Arctic Front Advance for Single-Shot Pulmonary Vein Isolation

“…Meanwhile, a second CB-system (POLARx, Boston Scientific) became available. First clinical experiences with this novel system reported comparable efficacy and safety, but differences in terms of biophysiological parameters [14][15][16][17][18][19][20][21][22][23].…”

Predictive value of HMGB1 for atrial fibrillation recurrence after cryoballoon ablation in paroxysmal atrial fibrillation patients

“…Univariate logistic regression analysis revealed that serum HMGB1post released from the left atrium was associated with AF recurrence (OR: 3.90 [1.16–13.08], p = .03). Next, some common clinical risk factors for AF recurrence were adjusted in a multivariate logistic regression analysis based on previous literature, 19 , 20 , 21 clinical knowledge, and statistically significant covariates in univariate analysis. The risk factors included age, female sex, AF period, CHADS2‐VASc score, hypertension, diabetes mellitus, peripheral arterial diseases, LA diameter, LAVI, LVEF, and HMGB1post.…”

“…HMGB1post released from the left atrium was associated with AF recurrence (OR: 3.90 [1.16-13.08], p = .03). Next, some common clinical risk factors for AF recurrence were adjusted in a multivariate logistic regression analysis based on previous literature, [19][20][21] 2).…”