Matteo Anselmino1, Mario Matta1, Fabrizio D'ascenzo1, Carlo Pappone2, Vincenzo Santinelli2, T Jared Bunch3, Thomas Neumann4, Richard J Schilling5, Ross J Hunter5, Georg Noelker6, Martin Fiala7, Antonio Frontera8, Glyn Thomas8, Demosthenes Katritsis9, Pierre Jais10, Rukshen Weerasooriya11, Jonathan M Kalman12, Fiorenzo Gaita13. 1. Division of Cardiology, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital, University of Turin, Corso Dogliotti 24, Torino 10126, Italy. 2. Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy. 3. Intermountain Heart Institute, Intermountain Medical Center, Murray, UT, USA. 4. Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany. 5. Cardiovascular Biomedical Research Unit, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK. 6. Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany. 7. Department of Cardiology, Heart Centre, Hospital Podlesi as, Třinec, Czech Republic. 8. Department of Cardiology, Bristol Heart Institute, University Hospital Bristol NHS Trust, Bristol, UK. 9. Department of Cardiology, Athens Euroclinic, Athens, Greece. 10. Department of Cardiac Electrophysiology, Hopital Cardiologique du Haut-Leveque, Bordeaux-Pessac, France. 11. Department of Cardiac Electrophysiology, Hopital Cardiologique du Haut-Leveque, Bordeaux-Pessac, France University of Western Australia, Crawley, Western Australia, Australia. 12. Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia. 13. Division of Cardiology, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital, University of Turin, Corso Dogliotti 24, Torino 10126, Italy fiorenzo.gaita@unito.it.
Abstract
AIMS: Diabetes mellitus (DM) and atrial fibrillation (AF) share pathophysiological links, as supported by the high prevalence of AF within DM patients. Catheter ablation of AF (AFCA) is an established therapeutic option for rhythm control in drug resistant symptomatic patients. Its efficacy and safety among patients with DM is based on small populations, and long-term outcome is unknown. The present systematic review and meta-analysis aims to assess safety and long-term outcome of AFCA in DM patients, focusing on predictors of recurrence. METHODS AND RESULTS: A systematic review was conducted in MEDLINE/PubMed and Cochrane Library. Randomized controlled trials, clinical trials, and observational studies including patients with DM undergoing AFCA were screened and included if matching inclusion and exclusion criteria. Fifteen studies were included, adding up to 1464 patients. Mean follow-up was 27 (20-33) months. Overall complication rate was 3.5 (1.5-5.0)%. Efficacy in maintaining sinus rhythm at follow-up end was 66 (58-73)%. Meta-regression analysis revealed that advanced age (P < 0.001), higher body mass index (P < 0.001), and higher basal glycated haemoglobin level (P < 0.001) related to higher incidence of arrhythmic recurrences. Performing AFCA lead to a reduction of patients requiring treatment with antiarrhythmic drugs (AADs) from 55 (46-74)% at baseline to 29 (17-41)% (P < 0.001) at follow-up end. CONCLUSIONS: Catheter ablation of AF safety and efficacy in DM patients is similar to general population, especially when performed in younger patients with satisfactory glycemic control. Catheter ablation of AF reduces the amount of patients requiring AADs, an additional benefit in this population commonly exposed to adverse effects of AF pharmacological treatments. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Diabetes mellitus (DM) and atrial fibrillation (AF) share pathophysiological links, as supported by the high prevalence of AF within DMpatients. Catheter ablation of AF (AFCA) is an established therapeutic option for rhythm control in drug resistant symptomatic patients. Its efficacy and safety among patients with DM is based on small populations, and long-term outcome is unknown. The present systematic review and meta-analysis aims to assess safety and long-term outcome of AFCA in DMpatients, focusing on predictors of recurrence. METHODS AND RESULTS: A systematic review was conducted in MEDLINE/PubMed and Cochrane Library. Randomized controlled trials, clinical trials, and observational studies including patients with DM undergoing AFCA were screened and included if matching inclusion and exclusion criteria. Fifteen studies were included, adding up to 1464 patients. Mean follow-up was 27 (20-33) months. Overall complication rate was 3.5 (1.5-5.0)%. Efficacy in maintaining sinus rhythm at follow-up end was 66 (58-73)%. Meta-regression analysis revealed that advanced age (P < 0.001), higher body mass index (P < 0.001), and higher basal glycated haemoglobin level (P < 0.001) related to higher incidence of arrhythmic recurrences. Performing AFCA lead to a reduction of patients requiring treatment with antiarrhythmic drugs (AADs) from 55 (46-74)% at baseline to 29 (17-41)% (P < 0.001) at follow-up end. CONCLUSIONS: Catheter ablation of AF safety and efficacy in DMpatients is similar to general population, especially when performed in younger patients with satisfactory glycemic control. Catheter ablation of AF reduces the amount of patients requiring AADs, an additional benefit in this population commonly exposed to adverse effects of AF pharmacological treatments. Published on behalf of the European Society of Cardiology. All rights reserved.
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Authors: Bulent Gorenek; Antonio Pelliccia; Emelia J Benjamin; Giuseppe Boriani; Harry J Crijns; Richard I Fogel; Isabelle C Van Gelder; Martin Halle; Gulmira Kudaiberdieva; Deirdre A Lane; Torben Bjerregaard Larsen; Gregory Y H Lip; Maja-Lisa Løchen; Francisco Marín; Josef Niebauer; Prashanthan Sanders; Lale Tokgozoglu; Marc A Vos; David R Van Wagoner; Laurent Fauchier; Irina Savelieva; Andreas Goette; Stefan Agewall; Chern-En Chiang; Márcio Figueiredo; Martin Stiles; Timm Dickfeld; Kristen Patton; Massimo Piepoli; Ugo Corra; Pedro Manuel Marques-Vidal; Pompilio Faggiano; Jean-Paul Schmid; Ana Abreu Journal: Europace Date: 2017-02-01 Impact factor: 5.214
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Authors: Hai Deng; Ying Bai; Alena Shantsila; Laurent Fauchier; Tatjana S Potpara; Gregory Y H Lip Journal: Clin Res Cardiol Date: 2017-05-30 Impact factor: 5.460