Beneficial effect of pioglitazone on the outcome of catheter ablation in patients with paroxysmal atrial fibrillation and type 2 diabetes mellitus

AIMS: Pioglitazone, one of the peroxisome proliferator-activated receptor-gamma activators, possesses anti-inflammatory and antioxidant properties. In the present study, we sought to identify the impact of pioglitazone on the outcome of catheter ablation for paroxysmal atrial fibrillation (PAF). METHODS AND RESULTS: We conducted a prospective observational cohort study of 150 consecutive patients undergoing catheter ablation of drug-refractory PAF. All patients had a history of type 2 diabetes mellitus (T2DM) and were divided based on whether they received pioglitazone before ablation or not. After grouping, 51 patients treated with pioglitazone and 99 control subjects were followed up at least 15 months after ablation. After a single ablation, sinus rhythm was maintained in 44 patients (86.3%) of the pioglitazone group vs. 70 patients (70.7%) of the control group (P = 0.034) without antiarrhythmic drug during a mean follow-up of 22.9 ± 5.1 months. The second ablation was performed in 5 patients (9.8%) from the pioglitazone group and in 24 patients (24.2%) from the control group (P = 0.034). Multivariate logistic analysis showed left atrium diameter was associated with a high risk of atrial tachyarrhythmias recurrence, and treatment with renin-angiotensin system inhibitor as well as pioglitazone was associated with a reduced atrial tachyarrhythmias recurrence rate. CONCLUSION: Pioglitazone improved the preservation of sinus rhythm and reduced the reablation rate in patients with PAF and T2DM after catheter ablation.