Background

Atrial fibrillation (AF) and diabetes mellitus (DM) are often coinciding diseases. The impact of DM on the development of an arrhythmia substrate is still not completely understood. Therefore, this study aimed to evaluate the outcome of pulmonary vein isolation (PVI) using a cryoballoon in patients (pts) suffering from AF and DM.

Methods

523 consecutive pts undergoing initial PVI using the 2^nd generation cryoballoon were analyzed. 273 pts (52%) suffered from paroxysmal AF (PAF) (51 ± 23.2 years old, 26% female) and 250 pts (48%) from persistent AF (PERS) (63.9 ± 10.0 years old, 30% female). 69 pts (13%) were diagnosed with DM (68 ± 19.6 years old, 30% female). Follow-up (FU) visits were performed at 3, 6 and 12 months including 7-day Holter ECGs. Primary endpoint was the first documented recurrence of any atrial arrhythmia (> 30 sec.).

Results

During a mean FU period of 12 months arrhythmia recurrence was observed in 29% (n=151 pts). Pts suffering from PAF were significantly younger than those with PERS, irrespective of the coincidence of DM (p=0.001*). Kaplan Meier analysis revealed a significantly higher risk for arrhythmia recurrence when PAF pts additionally suffered from DM (p=0.047*). In this sub cohort, multivariate analyses confirmed DM as a strong independent predictor (IP) associated with a >4-fold higher risk for arrhythmia recurrence (p=0.009*, hazard ratio (HR) 4.363, confidence interval (CI) 1.46-13.07). In pts with PERS, there was a trend towards an increased risk for arrhythmia recurrence when additional DM was diagnosed (p=0.218). In these patients, multivariate analyses found that DM was associated with a 43% higher risk for arrhythmia recurrence (p=0.321, HR 1.143, CI 059-2.22). In pts with PERS  severe gender disparities were observed as stepwise forward regression model calculation verified female gender as IP for arrhythmia-recurrence (p=0.027*, HR 1.927, CI 1.079-3.440).

Conclusion

DM has relevant effects on arrhythmia recurrence after PVI and our data demonstrated a stronger effect of ablation in PAF. This could be related to more substantial structural changes (like fibrosis) in patients suffering from PERS and DM. Consequently, personalized paths in arrhythmia management are needed in this specific cohort of patients with AF and DM.