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

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...

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Autores principales:	Denise Guckel, Khuraman Isgandarova, Leonard Bergau, Misagh Piran, Mustapha El Hamriti, Guram Imnadze, Martin Braun, Moneeb Khalaph, Thomas Fink, Vanessa Sciacca, Georg Nölker, Young-Hee Lee-Barkey, Diethelm Tschöpe, Philipp Sommer, Christian Sohns
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	diabetes mellitus atrial fibrillation ablation pulmonary vein isolation cryoballoon fibrosis Medicine R
Acceso en línea:	https://doaj.org/article/69be5d7a167940629a1ff3782342ece0
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spelling	oai:doaj.org-article:69be5d7a167940629a1ff3782342ece02021-11-11T17:31:29ZThe Effect of Diabetes Mellitus on the Recurrence of Atrial Fibrillation after Ablation10.3390/jcm102148632077-0383https://doaj.org/article/69be5d7a167940629a1ff3782342ece02021-10-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/21/4863https://doaj.org/toc/2077-0383Diabetes 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 <i>p</i> < 0.001 ). Multivariate analyses found DM to be an independent predictor (IP) for AF recurrence (<i>p</i> = 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 (<i>p</i> = 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.Denise GuckelKhuraman IsgandarovaLeonard BergauMisagh PiranMustapha El HamritiGuram ImnadzeMartin BraunMoneeb KhalaphThomas FinkVanessa SciaccaGeorg NölkerYoung-Hee Lee-BarkeyDiethelm TschöpePhilipp SommerChristian SohnsMDPI AGarticlediabetes mellitusatrial fibrillationablationpulmonary vein isolationcryoballoonfibrosisMedicineRENJournal of Clinical Medicine, Vol 10, Iss 4863, p 4863 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	diabetes mellitus atrial fibrillation ablation pulmonary vein isolation cryoballoon fibrosis Medicine R
spellingShingle	diabetes mellitus atrial fibrillation ablation pulmonary vein isolation cryoballoon fibrosis Medicine R Denise Guckel Khuraman Isgandarova Leonard Bergau Misagh Piran Mustapha El Hamriti Guram Imnadze Martin Braun Moneeb Khalaph Thomas Fink Vanessa Sciacca Georg Nölker Young-Hee Lee-Barkey Diethelm Tschöpe Philipp Sommer Christian Sohns The Effect of Diabetes Mellitus on the Recurrence of Atrial Fibrillation after Ablation
description	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 <i>p</i> < 0.001 ). Multivariate analyses found DM to be an independent predictor (IP) for AF recurrence (<i>p</i> = 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 (<i>p</i> = 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.
format	article
author	Denise Guckel Khuraman Isgandarova Leonard Bergau Misagh Piran Mustapha El Hamriti Guram Imnadze Martin Braun Moneeb Khalaph Thomas Fink Vanessa Sciacca Georg Nölker Young-Hee Lee-Barkey Diethelm Tschöpe Philipp Sommer Christian Sohns
author_facet	Denise Guckel Khuraman Isgandarova Leonard Bergau Misagh Piran Mustapha El Hamriti Guram Imnadze Martin Braun Moneeb Khalaph Thomas Fink Vanessa Sciacca Georg Nölker Young-Hee Lee-Barkey Diethelm Tschöpe Philipp Sommer Christian Sohns
author_sort	Denise Guckel
title	The Effect of Diabetes Mellitus on the Recurrence of Atrial Fibrillation after Ablation
title_short	The Effect of Diabetes Mellitus on the Recurrence of Atrial Fibrillation after Ablation
title_full	The Effect of Diabetes Mellitus on the Recurrence of Atrial Fibrillation after Ablation
title_fullStr	The Effect of Diabetes Mellitus on the Recurrence of Atrial Fibrillation after Ablation
title_full_unstemmed	The Effect of Diabetes Mellitus on the Recurrence of Atrial Fibrillation after Ablation
title_sort	effect of diabetes mellitus on the recurrence of atrial fibrillation after ablation
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/69be5d7a167940629a1ff3782342ece0
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The Effect of Diabetes Mellitus on the Recurrence of Atrial Fibrillation after Ablation

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