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

M. Anselmino, M. Matta, F. D'Ascenzo, C. Pappone, V. Santinelli, T.J. Bunch, T. Neumann, R.J. Schilling, R.J. Hunter, G. Noelker, M. Fiala, A. Frontera, G. Thomas, D. Katritsis, P. Jais, Hemal Weerasooriya, J.M. Kalman, F. Gaita

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    37 Citations (Scopus)

    Abstract

    © The Author 2015. 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
    JournalEuropace
    Volume17
    Issue number10
    DOIs
    Publication statusPublished - 2015

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