Catheter ablation of atrial fibrillation in patients with diabetes mellitus type 2: results from a randomized study comparing pulmonary vein isolation versus antiarrhythmic drug therapy.
BACKGROUND
Atrial fibrillation (AF) and diabetes mellitus type 2 (DM2) often coexist; however, a small number of patients with DM2 undergoing catheter ablation (CA) of AF have been included in previous studies. The aim of this study was to evaluate safety and efficacy of ablation therapy in DM2 patients with drug refractory AF.


RESULTS
From January 2005 to September 2006, 70 patients with a diagnosis of DM2 and paroxysmal (n = 29) or persistent (n = 41) AF were randomized to receive either pulmonary vein isolation or a new antiarrhythmic drug treatment (ADT) with a 1-year follow-up. The primary endpoint was the time to first AF recurrence. By Kaplan-Meier analysis, at the end of follow-up, 42.9% of patients in the ADT group and 80% of patients who received a single ablation procedure and were without medications were free of AF (P = 0.001). In the ablation group, a significant improvement in quality-of-life (QoL) scores as compared with ADT group was observed. Six patients in the ADT group (17.1%) developed significant adverse drug effects. Hospitalization rate during follow-up was higher in the ADT group (P = 0.01). The only complication attributable to ablation was one significant access-site hematoma.


CONCLUSIONS
In patients with DM2, CA of AF provides significant clinical benefits over the ADT and appears to be a reasonable approach regarding feasibility, effectiveness, and low procedural risk.
Forleo
Giovanni B
GB
Cardiac Arrhythmia and Heart Failure Research Center, St. Camillo-Forlanini Hospital, Catholic University of Sacred Heart, Rome, Italy.
Mantica
Massimo
M
De Luca
Lucia
L
Leo
Roberto
R
Santini
Luca
L
Panigada
Stefania
S
De Sanctis
Valerio
V
Pappalardo
Augusto
A
Laurenzi
Francesco
F
Avella
Andrea
A
Casella
Michela
M
Dello Russo
Antonio
A
Romeo
Francesco
F
Pelargonio
Gemma
G
Tondo
Claudio
C
D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications* / Q000628:therapy*; D017115:Catheter Ablation / Q000379:methods*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000628:therapy*; D005260:Female; D006329:Heart Conduction System / Q000601:surgery*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents