Diabetes and ALDH2 Gene Polymorphism on Post-Ablation Atrial Fibrillation Recurrence

Figures

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  Figure 1. Study Flowchart The multicenter, prospective enrollment of patients from 3 participating hospitals between 2022 and 2024. Among 342 patients with atrial fibrillation (AF) who underwent initial successful ablation, 324 were included in the final analysis. Genotype analysis revealed ALDH2 (aldehyde dehydrogenase 2) variant in 43 type 2 diabetes mellitus (T2DM) and 95 non-T2DM patients, and ALDH2 wild-type in 45 T2DM and 141 non-T2DM patients. The primary endpoint was AF recurrence. RFCA = radiofrequency catheter ablation.

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  Figure 2. AF Recurrence by Diabetes Status This Kaplan–Meier curve shows the cumulative incidence of AF recurrence following RFCA, stratified by T2DM status. At 1-year follow-up, patients with T2DM exhibited a significantly higher cumulative incidence of AF recurrence compared to those without T2DM. Log-rank testing was used to compare the 2 groups. Abbreviations as in Figure 1.

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  Figure 3. AF Recurrence by T2DM Status and ALDH2 Genotype This figure shows the cumulative incidence of AF recurrence one year after RFCA across four groups combining T2DM status and ALDH2 genotype. Patients were categorized as: non-T2DM and ALDH2-wild (Group A), non-T2DM and ALDH2-variant (Group B), T2DM and ALDH2-wild (Group C), and T2DM and ALDH2-variant (Group D). Recurrence rates were 16.3%, 25.3%, 33.3%, and 55.8%, respectively. Group D had a significantly higher recurrence risk than all other groups (p<0.001). DM = diabetes mellitus; other abbreviations as in Figure 1.

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  Figure 4. Subgroup Analyses for the Primary Endpoint of AF Recurrence Subgroup analyses evaluating the association between T2DM with ALDH2-variant genotype and AF recurrence after RFCA. Consistent treatment effects were observed across all prespecified subgroups, including sex, age, AF type, amiodarone use, hypertension, and left atrium diameter (LAD). No significant interaction was found in any subgroup (all P-interaction > 0.05), indicating the robustness of the primary outcome. Abbreviations as in Figure 1.

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  Central Illustration. Impact of T2DM and ALDH2 Genotype on AF Recurrence Post-Ablation This multicenter prospective study of 324 patients undergoing initial catheter ablation revealed that the combination of type 2 diabetes mellitus (T2DM) and the ALDH2 (aldehyde dehydrogenase 2) variant was the most powerful independent predictor of atrial fibrillation (AF) recurrence at 1 year (adjusted HR: 4.20; 95% CI: 2.04-8.64; P < 0.001). RFCA = radiofrequency catheter ablation.