The effect of diabetic autonomic neuropathy on P-wave duration, dispersion and atrial fibrillation

Abstract

IntroductionAtrial fibrillation (AF) is the most common sustained arrhythmia. Diabetic autonomic neuropathy (DAN) is a frequent complication of diabetes mellitus and has a negative impact on the cardiovascular system. There are no data about the occurrence of paroxysmal atrial fibrillation (PAF) in the population with DAN.Material and methodsWe analysed the data of 100 patients with PAF. The study population was divided into three groups: group I: 28 patients with diabetes mellitus (DM) and DAN, group II: 34 patients with DM without DAN, and group III: 38 patients without DM. P-wave duration (FPD) and dispersion (PWD) were measured during sinus rhythm and AF episodes were counted during 12 months of follow-up.ResultsRecurrence of PAF was higher in group I (47 episodes/year) compared to groups II and III (26 and 22 episodes/year) – p<0.01. The FPD was longer in group I (137.4 ±12.0 ms vs. 126 ±23.0 ms in II group and 129 ±18.3 ms in group III; p<0.001). The PWD was longer in patients with DAN (53 ±19 ms vs. 36 ±18 ms and 34 ± 20 ms, p<0.001).ConclusionsThe results showed that the presence of DAN caused a significant increase in P-wave duration and dispersion, which might be responsible for the recurrence of AF.

Prevalence and clinical features of atrial fibrillation in diabetic neuropathy: a cross-sectional, observational study

“…According to the results of study of Kanorski et al (7) comparison of patient groups of with and without DAN revealed augmentation of adrenergic influences on the heart and comparatively higher anti-recurrence efficacy of sotalol among patients with diabetic autonomic neuropathy. In the study of Bissinger et al (8) recurrence of paroxysmal AF was higher in patient group with DAN compared to patient group without DAN (p<0.01). The results also showed that the presence of diabetic autonomic neuropathy caused a significant increase in P-wave duration and dispersion, which might be responsible for the recurrence of AF (8).…”

“…In the study of Bissinger et al (8) recurrence of paroxysmal AF was higher in patient group with DAN compared to patient group without DAN (p<0.01). The results also showed that the presence of diabetic autonomic neuropathy caused a significant increase in P-wave duration and dispersion, which might be responsible for the recurrence of AF (8). This study evaluated only recurrence rate of paroxysmal AF.…”

“…Kanorski et al (7) compared patient groups of with and without diabetic autonomic neuropathy (DAN) and found augmentation of adrenergic influences on the heart and comparatively higher anti-recurrence efficacy of sotalol among patients with DAN. In the study of Bissinger et al (8) recurrence of paroxysmal AF was higher in patient group with DAN compared to patient group without DAN. These studies evaluated only recurrence rates of paroxysmal AF and/or efficacy of beta-blocker treatment on these recurrence rates in patients with DAN.…”

“…It has been shown that, diabetes is also associated with increased risk of AF (6). The influence of autonomic neuropathy on the development of AF in patients with diabetes was not studied previously except the studies of Kanorski et al (7) and Bissinger et al (8). Autonomic nerve activity plays an important role in cardiac cellular electrophysiology and in the pathogenesis of AF (9).…”

Metabolic syndrome, atrial fibrillation, and stroke: Tackling an emerging epidemic

“…43,44 Together with associated autonomic neuropathy, these favour the development of AF. 27,45 Hypertension is also an important independent risk factor. Left atrial enlargement, slowing of atrial conduction and activation of the renin-angiotensin system all increase AF risk.…”