Atrial fibrillation ablation in patients with type 2 diabetes mellitus: long-term follow-up study for atrial tachyarrhythmia recurrence and adverse cardiovascular events

Background Type 2 diabetes mellitus (T2DM) is a modifiable risk factor both for atrial fibrillation (AF) and for the development of cerebrovascular-events in patients with AF. The aim of our study was to determine the effect of cryoballoon ablation (CBA) treatment on long-term atrial-tachyarrhythmia recurrence and adverse cardiovascular (CV) events in paroxysmal AF patients with T2DM. Methods This retrospective-observational-cohort study included 748-patients (406-male,342-female,59.4 ± 11.8years) who underwent CBA with a diagnosis of paroxysmal AF between 2013−2023. The primary endpoint was atrial tachyarrhythmia recurrence (After-CBA≥3months) and the secondary endpoint was development of CV-events (CV mortality, non-fatal myocardial infarction and cerebrovascular-events). All patients were followed up for at least 24 months for atrial-tachyarrhythmia recurrence and CV event development. Results The prevalence of T2DM was 26% in patients who underwent CBA. Atrial-tachyarrhythmia recurrence and CV events were more frequent in the T2DM group (24%vs15%, p = 0.004 and 33%vs9%, p = 0.045, respectively). Systolic-diastolic blood pressure, female gender, frequency of T2DM and anti-diabetic drug use, and left atrial diameter (LAd) values were higher in patients with atrial-tachyarrhythmia recurrence ( p < 0.05). The presence of LAd and T2DM were shown to independently predict the development of atrial-tachyarrhythmia recurrence (OR = 1.235,95%CI-1.169-1.305, p < 0.001andOR = 1.843,95%CI-1.116-3.406, p = 0.030). Male-gender and presence of T2DM, CHA 2 DS 2 -VA score and uric-acid were shown to independently predict CV events (OR = 1.906,95%CI1.102-3.299, p = 0.021,OR = 2.148,95%CI-1.073-4.303, p = 0.013,OR = 1.613,95%CI-1.346-1.932, p = 0.001andOR = 1.322,95%CI-1.125-1.554, p = 0.001). Conclusion The presence of T2DM is an important, independent and modifiable risk factor for both atrial-tachyarrhythmia recurrence and adverse CV events in patients treated with CBA for AF. It was concluded that comprehensive management of T2DM is necessary to improve long-term outcomes of CBA.