Key result
Type 2 diabetes mellitus did not significantly affect 5-year freedom from atrial fibrillation after surgical ablation compared to non-diabetic patients (71.5% vs 74.1%), though it was associated with increased 5-year mortality (23.4% vs 11.1%).
Why the study?
Diabetes mellitus type 2 is an independent risk factor for atrial fibrillation, but its impact on early and long-term outcomes following surgical ablation was unclear.
Does Diabetes Mellitus type 2 impact freedom from recurrent atrial arrhythmia and mortality in patients undergoing surgical ablation for atrial fibrillation?
Cohort (n=606)
No
Does Diabetes Mellitus type 2 impact freedom from recurrent atrial arrhythmia and mortality in patients undergoing surgical ablation for atrial fibrillation?
Absolute Event Rate: 71.5% vs 74.1%
p-value: p=0.622
Surgical ablation for atrial fibrillation is equally effective at maintaining sinus rhythm in patients with and without type 2 diabetes up to 5 years, though diabetic patients face a higher 5-year mortality risk.
DM type 2 does not reduce AF freedom after surgical ablation; leaves open whether higher 5-year mortality warrants targeted strategies.
BACKGROUND: Diabetes mellitus (DM) type 2 is an independent risk factor for atrial fibrillation (AF). Surgical ablation or "maze procedure" is an option for patients with AF undergoing concomitant or isolated cardiac surgery. The aim of this study was to evaluate the impact of DM type 2 on early and long-term outcomes of patients following surgical AF ablation. METHODS: We performed an observational cohort study in Israel's largest tertiary care center. All data of patients who underwent surgical AF ablation, between 2006 and 2021 were extracted from our departmental database. Patients were divided into Group I (non-diabetic patients) and Group II (DM type 2 patients). We compared the two groups with respect to freedom from recurrent atrial arrhythmia, and mortality rate. RESULTS: The study population included 606 patients. Group I (non-DM patients), consisting of 484 patients, and Group II (DM type 2 patients), comprised 122 patients. Patients with DM were older, had more hypertension and incidence of cerebrovascular accident (CVA)/transient ischemic attack (TIA), higher EuroSCORE (p < .05 for all), and a longer bypass time-130 ± 40 vs. 122 ± 36 min (p = 0.028). The mean follow-up duration was 39.0 ± 22.7 months. Freedom from atrial fibrillation was similar between the non-DM and DM type 2 groups after a 1-year follow-up, 414 (88.2%) vs. 101 (87.1%) (p = 0.511), after a 3-year follow-up, 360 (86.3%) vs. 84 (79.9%) (p = 0.290) and after a 5-year follow-up, 226 (74.1%) vs. 55 (71.5%) (p = 0.622) respectively. Furthermore, 1- and 3-year mortality was similar between non-DM and DM type 2 groups, 2.5% vs. 4.9%, (p = 0.226) and 5.6% vs. 10.5% (p = 0.076) respectively. 5-year mortality was higher in Group II (DM type 2 patients) compared with Group I (non-DM patients), 11.1% vs. 23.4% (p = 0.009). CONCLUSION: Surgical ablation had a high success rate, with freedom from recurrent atrial arrhythmia at 1- 3- and 5- years follow-up in both the DM type 2 and non-DM groups. Furthermore,1- and 3-year mortality after surgical ablation was also similar in both groups. However, 5-year mortality was higher in the DM type 2 group.
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Kogan et al. (2023) conducted a cohort in Atrial fibrillation (n=606). Type 2 Diabetes Mellitus vs. Non-diabetic patients was evaluated on 5-year freedom from atrial fibrillation (p=0.622). Type 2 diabetes mellitus did not significantly affect 5-year freedom from atrial fibrillation after surgical ablation compared to non-diabetic patients (71.5% vs 74.1%), though it was associated with increased 5-year mortality (23.4% vs 11.1%).
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