Diabetes Influences the Cardiac Symptoms Related to Atrial Fibrillation

It is well known that diabetes mellitus (DM) masks the cardiac symptoms during an ischemic heart attack, but there have not been reports of whether DM influences the subjective symptoms of atrial fibrillation (AF). The present study retrospectively assessed 65 patients who were revealed to be in sinus rhythm at their first visit to hospital and who had experienced episodes of AF (or paroxysmal AF) during the follow-up period. Compared with non-DM cases (n=50), DM patients (n=15) had a tendency to a more rapid heart rate in sinus rhythm (73+/-4 vs 66+/-2, p=0.07) and higher averaged ventricular response at the first-recorded episode of AF (111+/-7 vs 99+/-3, p=0.10). However, the ratio of symptomatic cases at first-recorded AF tended to be lower in DM cases (33% vs 58%, p=0.08). When patients with beta-blockers or other antiarrhythmic agents were excluded, the ratio of symptomatic patients at first-recorded AF was significantly lower in the DM cases (25% vs 61%, p=0.04), although there was not a significant difference in averaged ventricular response at first-recorded AF (112+/-8 vs 106+/-5). The prevalence of DM neuropathy was significantly higher in asymptomatic patients (70% vs 0%, p=0.01). DM may mask the cardiac symptoms of the first-recorded episode of AF, possibly because of DM neuropathy.