Diabetes Mellitus and Its Role in the Development and Progression of Atrial Fibrillation: A Review and Recommendations

Millions worldwide suffer from a chronic metabolic disorder called type 2 diabetes mellitus.Atrial fibrillation is the most common persistent arrhythmic condition that increases the risk of heart and brain complications.Recent studies depict that diabetic patients have a higher chance of developing AF, but the exact link between these two conditions is unclear.We discuss the current understanding of how AF and Diabetes are related based on the following aspects: electrical, electromechanical, structural, and oxidative stress changes, connexin remodeling, and glycemic fluctuations.Additionally, we explore other potential mechanisms, including inflammation, autonomic dysfunction, obesity, microvascular disease, metabolic factors, hyperglycemia, and renal dysfunction.We also summarize the clinical studies investigating the outcomes and management of patients with AF and Diabetes.We review the available treatment options, such as anti-diabetic and anti-arrhythmic drugs, and nonpharmacological interventions, such as cardioversion, catheter ablation, and direct current cardioversion.This review provides valuable insights into the multifaceted relationship between Diabetes mellitus and its role in the development and progression of atrial fibrillation, offering recommendations for understanding and managing this complex interplay.