Catheter ablation of atrial fibrillation in patients with diabetes mellitus: a systematic review and meta-analysis.
OBJECTIVE
Diabetes mellitus (DM) and atrial fibrillation (AF) share pathophysiological links, as supported by the high prevalence of AF within DM patients. Catheter ablation of AF (AFCA) is an established therapeutic option for rhythm control in drug resistant symptomatic patients. Its efficacy and safety among patients with DM is based on small populations, and long-term outcome is unknown. The present systematic review and meta-analysis aims to assess safety and long-term outcome of AFCA in DM patients, focusing on predictors of recurrence.


RESULTS
A systematic review was conducted in MEDLINE/PubMed and Cochrane Library. Randomized controlled trials, clinical trials, and observational studies including patients with DM undergoing AFCA were screened and included if matching inclusion and exclusion criteria. Fifteen studies were included, adding up to 1464 patients. Mean follow-up was 27 (20-33) months. Overall complication rate was 3.5 (1.5-5.0)%. Efficacy in maintaining sinus rhythm at follow-up end was 66 (58-73)%. Meta-regression analysis revealed that advanced age (P < 0.001), higher body mass index (P < 0.001), and higher basal glycated haemoglobin level (P < 0.001) related to higher incidence of arrhythmic recurrences. Performing AFCA lead to a reduction of patients requiring treatment with antiarrhythmic drugs (AADs) from 55 (46-74)% at baseline to 29 (17-41)% (P < 0.001) at follow-up end.


CONCLUSIONS
Catheter ablation of AF safety and efficacy in DM patients is similar to general population, especially when performed in younger patients with satisfactory glycemic control. Catheter ablation of AF reduces the amount of patients requiring AADs, an additional benefit in this population commonly exposed to adverse effects of AF pharmacological treatments.
Division of Cardiology, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital, University of Turin, Corso Dogliotti 24, Torino 10126, Italy.
Matteo
M
Anselmino
Division of Cardiology, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital, University of Turin, Corso Dogliotti 24, Torino 10126, Italy.
Mario
M
Matta
Division of Cardiology, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital, University of Turin, Corso Dogliotti 24, Torino 10126, Italy.
Fabrizio
F
D'ascenzo
Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
Carlo
C
Pappone
Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
Vincenzo
V
Santinelli
Intermountain Heart Institute, Intermountain Medical Center, Murray, UT, USA.
T Jared
TJ
Bunch
Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.
Thomas
T
Neumann
Cardiovascular Biomedical Research Unit, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
Richard J
RJ
Schilling
Cardiovascular Biomedical Research Unit, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
Ross J
RJ
Hunter
Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany.
Georg
G
Noelker
Department of Cardiology, Heart Centre, Hospital Podlesi as, Třinec, Czech Republic.
Martin
M
Fiala
Department of Cardiology, Bristol Heart Institute, University Hospital Bristol NHS Trust, Bristol, UK.
Antonio
A
Frontera
Department of Cardiology, Bristol Heart Institute, University Hospital Bristol NHS Trust, Bristol, UK.
Glyn
G
Thomas
Department of Cardiology, Athens Euroclinic, Athens, Greece.
Demosthenes
D
Katritsis
Department of Cardiac Electrophysiology, Hopital Cardiologique du Haut-Leveque, Bordeaux-Pessac, France.
Pierre
P
Jais
Department of Cardiac Electrophysiology, Hopital Cardiologique du Haut-Leveque, Bordeaux-Pessac, France University of Western Australia, Crawley, Western Australia, Australia.
Rukshen
R
Weerasooriya
Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia.
Jonathan M
JM
Kalman
Division of Cardiology, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital, University of Turin, Corso Dogliotti 24, Torino 10126, Italy fiorenzo.gaita@unito.it.
Fiorenzo
F
Gaita
D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000628:therapy*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D048909:Diabetes Complications; D006801:Humans; D012008:Recurrence; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents
Atrial fibrillation; Catheter ablation; Diabetes mellitus; Meta-analysis; Rhythm control