Impact of Type-2 Diabetes Mellitus on the Outcomes of Catheter Ablation of Atrial Fibrillation (European Observational Multicentre Study).

Type-2 diabetes mellitus (DM) is associated with an increased risk of atrial fibrillation (AF). It is unclear whether DM is a risk factor for arrhythmia recurrence following catheter ablation of AF. We performed a nonrandomised, observational study in 7 high-volume European centres. A total of 2,504 patients who underwent catheter ablation of AF were included, and procedural outcomes were compared among patients with or without DM. Patients with DM (234) accounted for 9.3% of the sample, and were significantly older, had a higher BMI and suffered more frequently from persistent AF. Arrhythmia relapses at 12 months after AF ablation occurred more frequently in the DM group (32.0% vs 25.3%, p = 0.031). After adjusting for type of AF (i.e., paroxysmal vs persistent), during a median follow-up of 17 ± 16 months, atrial arrhythmia free-survival was lower in the diabetics with persistent AF (log-rank p = 0.003), and comparable for paroxysmal AF (log-rank p = 0.554). These results were confirmed in a propensity-matched analysis, and DM was also an independent predictor of AF recurrence on the multivariate analysis (hazard ratio 1.39; 95% confidence interval _95% 1.07 to 1.88; p = 0.016). There was no significant difference in the rate of periprocedural complications among DM and non-DM patients (3.8% vs 6.3%, p = 0.128). Efficacy and safety of cryoballoon ablation were comparable to radiofrequency ablation in both DM and no-DM groups. In conclusion, catheter ablation of AF appears to be safe in patients with DM. However, DM is associated with higher rate of atrial arrhythmia relapse, particularly for patients with persistent AF.
Competing Interests: Disclosures and conflicts of interest AC has received educational grants from Boston Scientific and Abbott; JPL has received consultant fees from Abbott, and Biosense Webster; FA has received compensatory fees from Boston Scientific, Medtronic, and LivaNova; SB has received consulting fees from Medtronic, Boston Scientific, and Sorin Group; CdA receive compensation for teaching purposes and proctoring from AF solutions, Medtronic, Abbott, Biotronik, Atricure and research grants on behalf of the centre from Biotronik, Medtronic, Abbott, Livanova, Boston Scientific, and Biosense Webster; GBC receive compensation for teaching purposes and proctoring from AF solutions, Medtronic, and Biotronik; RJS has had research agreements and speaker fees from Abbott, Medtronic, Boston Scientific, and Biosense Webster; PDL has received educational grants from Medtronic and Boston Scientific; MF has received speaker fees from Biotronik and Medtronic, and owns stocks of Epicardio ltd. All other authors have reported that they have no relation relevant to the contents of this study to disclose.
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