Poor glycemic control is associated with the prevalence of left atrial low-voltage areas in patients with atrial fibrillation ablation

Abstract

Abstract Background Although glycemic control before atrial fibrillation (AF) ablation is associated with AF recurrence after the procedure, the mechanism has not been fully clarified. Left atrial low-voltage areas (LVAs) were known to be correlated with atrial scarring and AF recurrence after ablation, and a preliminary study showed that the past history of diabetes mellitus (DM) was an independent predictor of LVAs. However, the association between LVAs and glycemic control before ablation has not been elucidated. Purpose The purpose of this study was to investigate the association between glycemic control before AF ablation and the prevalence of LVAs in patients with AF ablation. Methods The study design was a single center, retrospective observational study. Between December 2014 and December 2018, 782 (age, 68 ± 10 years; female, 262 [34%]; persistent AF, 414 [53%]) consecutive patients who underwent initial AF ablation were included. Glycated hemoglobin A1c (HbA1c) levels were measured before the procedure, and HbA1c ≥ 7% was set as the cut-off value of poor glycemic control in patients with DM. The definition of LVAs was sites with a left atrial bipolar amplitude < 0.5 mV covering as ≥ 5 cm². Rhythm outcome after the procedure was followed for 24 months. Results Of 782 patients, 162 (21%) patients had LVAs, and 135 (17%) patients had past history of DM. LVAs were found more frequently in patients with poor glycemic control (Figure 1). On multivariate analysis, DM with HbA1c ≥7% was an independent predictor of LVAs (odds ratio, 3.6; 95% confidence interval: 1.8–7.0; p < 0.001). In patients with LVAs, freedom from AF recurrence during the study periods tended to be lower in patients who had DM with HbA1c ≥7% than in those with non-DM (40.3% versus 51.6%, p = 0.06) (Figure 2). Conclusions In patients with AF ablation, LVAs were found more frequently in patients with poor glycemic control. In particular, DM with HbA1c ≥7% was an independent predictor of LVAs.Prevalence of LVAs and glycemic controlAF recurrence and glycemic control