Catheter ablation of atrial fibrillation in patients with diabetes mellitus: A systematic review and meta-analysis

Matteo Anselmino, Mario Matta, Fabrizio D'Ascenzo, Carlo Pappone, Vincenzo Santinelli, T. Jared Bunch, Thomas Neumann, Richard J. Schilling, Ross J. Hunter, Georg Noelker, Martin Fiala, Antonio Frontera, Glyn Thomas, Demosthenes Katritsis, Pierre Jais, Rukshen Weerasooriya, Jonathan M. Kalman, Fiorenzo Gaita

Research output: Contribution to journalArticle

Abstract

Aims: 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 drugresistant symptomatic patients. Its efficacy and safety among patients with DM is based on small populations, and longterm outcome is unknown. The present systematic review and meta-analysis aims to assess safety and long-term outcomeof AFCA in DM patients, focusing on predictors of recurrence. Methods and results: A systematic review was conducted in MEDLINE/PubMed and Cochrane Library. Randomized controlled trials, clinicaltrials, 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), andhigher 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 baselineto 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 inyounger 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.

Original languageEnglish
Pages (from-to)1518-1525
Number of pages8
JournalEuropace
Volume17
Issue number10
DOIs
Publication statusPublished - 2015

Keywords

  • Atrial fibrillation
  • Catheter ablation
  • Diabetes mellitus
  • Meta-analysis
  • Rhythm control

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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  • Cite this

    Anselmino, M., Matta, M., D'Ascenzo, F., Pappone, C., Santinelli, V., Bunch, T. J., Neumann, T., Schilling, R. J., Hunter, R. J., Noelker, G., Fiala, M., Frontera, A., Thomas, G., Katritsis, D., Jais, P., Weerasooriya, R., Kalman, J. M., & Gaita, F. (2015). Catheter ablation of atrial fibrillation in patients with diabetes mellitus: A systematic review and meta-analysis. Europace, 17(10), 1518-1525. https://doi.org/10.1093/europace/euv214