Of hits, players, and goalkeepers: the case of arrhythmias in diabetes

This editorial refers to ‘Two-hit mechanism of cardiac arrhythmias in diabetic hyperglycaemia: reduced repolarization reserve, neurohormonal stimulation, and heart failure exacerbate susceptibility’ by B. Hegyi et al., doi:10.1093/cvr/cvab006. The propensity to arrhythmias in diabetic patients has been recognized since a long time. The occurrence of atrial and ventricular arrhythmias is increased in diabetic patients often because of poor but also despite optimal glycaemic control.1 The 2019 European Society of Cardiology (ESC) guidelines for diabetes2 identify the abnormal substrate as a major culprit for sustained ventricular arrhythmias (‘The risk of cardiac events is usually dictated by underlying heart disease rather than ectopic beats’) and recommend a...