Abstract
A number of clinical studies have reported that diabetes mellitus (DM) is an independent risk factor for Atrial fibrillation (AF). After adjustment for other known risk factors including age, sex, and cardiovascular risk factors, DM remains a significant if modest risk factor for development of AF. The mechanisms underlying the increased susceptibility to AF in DM are incompletely understood, but are thought to involve electrical, structural, and autonomic remodeling in the atria. Electrical remodeling in DM may involve alterations in gap junction function that affect atrial conduction velocity due to changes in expression or localization of connexins. Electrical remodeling can also occur due to changes in atrial action potential morphology in association with changes in ionic currents, such as sodium or potassium currents, that can affect conduction velocity or susceptibility to triggered activity. Structural remodeling in DM results in atrial fibrosis, which can alter conduction patterns and susceptibility to re-entry in the atria. In addition, increases in atrial adipose tissue, especially in Type II DM, can lead to disruptions in atrial conduction velocity or conduction patterns that may affect arrhythmogenesis. Whether the insulin resistance in type II DM activates unique intracellular signaling pathways independent of obesity requires further investigation. In addition, the relationship between incident AF and glycemic control requires further study.
Highlights
Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with substantial morbidity and mortality
Some but not all studies have reported that diabetes mellitus (DM) is an independent risk factor for AF (Benjamin et al, 1994; Krahn et al, 1995; Huxley et al, 2011)
We will review the clinical data supporting the association between DM and AF and discuss the potential mechanism(s) by which DM may contribute to the electrophysiologic substrate for AF
Summary
Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with substantial morbidity and mortality. Some but not all studies have reported that diabetes mellitus (DM) is an independent risk factor for AF (Benjamin et al, 1994; Krahn et al, 1995; Huxley et al, 2011). This study reported that hypertension, diabetes, congestive heart failure and valvular heart disease were independent risk factors for AF in both men and women (Benjamin et al, 1994).
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