Catheter ablation of atrial fibrillation in patients with diabetes mellitus

Allen Wang, MD; Tracy Truong, MB; Eric Black-Maier, MD; Cynthia Green, PhD; Kristen B. Campbell, PharmD; Adam S. Barnett, MD; Janice Febre, BSN, RN; Zak Loring, MD, MHS; Sana M. Al-Khatib, MD, MHS, FHRS; Brett D. Atwater, MD; James P. Daubert, MD, FHRS; Camille Frazier-Mills, MD, MHS; Donald D. Hegland, MD; Kevin P. Jackson, MD; Larry R. Jackson, MD; Jason I. Koontz, MD, PhD; Robert K. Lewis, MD, PhD; Sean D. Pokorney, MD, MBA; Albert Y. Sun, MD; Kevin L. Thomas, MD; Tristam D. Bahnson, MD, FHRS; Jonathan P. Piccini, MD, MHS, FHRS

Heart Rhythm O2 (Aug 2020)

Catheter ablation of atrial fibrillation in patients with diabetes mellitus

Allen Wang, MD,
Tracy Truong, MB,
Eric Black-Maier, MD,
Cynthia Green, PhD,
Kristen B. Campbell, PharmD,
Adam S. Barnett, MD,
Janice Febre, BSN, RN,
Zak Loring, MD, MHS,
Sana M. Al-Khatib, MD, MHS, FHRS,
Brett D. Atwater, MD,
James P. Daubert, MD, FHRS,
Camille Frazier-Mills, MD, MHS,
Donald D. Hegland, MD,
Kevin P. Jackson, MD,
Larry R. Jackson, MD,
Jason I. Koontz, MD, PhD,
Robert K. Lewis, MD, PhD,
Sean D. Pokorney, MD, MBA,
Albert Y. Sun, MD,
Kevin L. Thomas, MD,
Tristam D. Bahnson, MD, FHRS,
Jonathan P. Piccini, MD, MHS, FHRS

Affiliations

Allen Wang, MD: Duke Center for Atrial Fibrillation, Department of Medicine, Duke University Medical Center, Durham, North Carolina
Tracy Truong, MB: Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
Eric Black-Maier, MD: Duke Center for Atrial Fibrillation, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
Cynthia Green, PhD: Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
Kristen B. Campbell, PharmD: Duke Center for Atrial Fibrillation, Department of Medicine, Duke University Medical Center, Durham, North Carolina
Adam S. Barnett, MD: Duke Center for Atrial Fibrillation, Department of Medicine, Duke University Medical Center, Durham, North Carolina
Janice Febre, BSN, RN: Duke Center for Atrial Fibrillation, Department of Medicine, Duke University Medical Center, Durham, North Carolina
Zak Loring, MD, MHS: Duke Center for Atrial Fibrillation, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
Sana M. Al-Khatib, MD, MHS, FHRS: Duke Center for Atrial Fibrillation, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
Brett D. Atwater, MD: Duke Center for Atrial Fibrillation, Department of Medicine, Duke University Medical Center, Durham, North Carolina
James P. Daubert, MD, FHRS: Duke Center for Atrial Fibrillation, Department of Medicine, Duke University Medical Center, Durham, North Carolina
Camille Frazier-Mills, MD, MHS: Duke Center for Atrial Fibrillation, Department of Medicine, Duke University Medical Center, Durham, North Carolina
Donald D. Hegland, MD: Duke Center for Atrial Fibrillation, Department of Medicine, Duke University Medical Center, Durham, North Carolina
Kevin P. Jackson, MD: Duke Center for Atrial Fibrillation, Department of Medicine, Duke University Medical Center, Durham, North Carolina
Larry R. Jackson, MD: Duke Center for Atrial Fibrillation, Department of Medicine, Duke University Medical Center, Durham, North Carolina
Jason I. Koontz, MD, PhD: Duke Center for Atrial Fibrillation, Department of Medicine, Duke University Medical Center, Durham, North Carolina
Robert K. Lewis, MD, PhD: Duke Center for Atrial Fibrillation, Department of Medicine, Duke University Medical Center, Durham, North Carolina
Sean D. Pokorney, MD, MBA: Duke Center for Atrial Fibrillation, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
Albert Y. Sun, MD: Duke Center for Atrial Fibrillation, Department of Medicine, Duke University Medical Center, Durham, North Carolina
Kevin L. Thomas, MD: Duke Center for Atrial Fibrillation, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
Tristam D. Bahnson, MD, FHRS: Duke Center for Atrial Fibrillation, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
Jonathan P. Piccini, MD, MHS, FHRS: Duke Center for Atrial Fibrillation, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina; Address reprint requests and correspondence: Dr Jonathan P. Piccini, Electrophysiology Section, Duke University Medical Center, Duke Clinical Research Institute, 200 Morris St, Durham, NC 27701.

Journal volume & issue: Vol. 1, no. 3
pp. 180 – 188

Abstract

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Background: 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. Objective: The purpose of this study was to compare AF ablation outcomes in patients with and those without DM. Methods: 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. Results: 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). Conclusion: 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.

Published in Heart Rhythm O2

ISSN: 2666-5018 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system
Website: https://www.journals.elsevier.com/heart-rhythm-o2

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