The long-term outcome of pulmonary vein isolation in paroxysmal atrial fibrillation is significantly influenced by diabetes mellitus in general as well as by an antidiabetic therapy

Abstract

Abstract Introduction Over the last decades pulmonary vein isolation became a cornerstone in the interventional treatment of paroxysmal atrial fibrillation. Postprocedural recurrences of atrial fibrillation are present in patients with and without concomitant cardiovascular diseases. Purpose The aim of this study was to assess the influence of diabetes mellitus and an antidiabetic therapy on the long-term outcome, defined as freedom of atrial fibrillation, of pulmonary vein isolation in patients with paroxysmal atrial fibrillation Methods All patients underwent pulmonary vein isolation using the combination of a radiofrequency ablation catheter, a pulmonary mapping catheter and a 3D electroanatomic mapping system. Every procedure was carried out according to current clinical and scientific standards. Procedural, clinical and follow-up data were stored for later statistical analysis. All patients received 4 follow-ups in total. In the first 12 postprocedural months patients were followed up after 3, 6 and 12 months. Furthermore, there was one long-term follow-up up to 6 years after the procedure. Results A total of n=1282 patients were included in the study. 39.2% of the patients were female and 60,8% were male. At the timepoint of the procedure the mean age was 63.7 years. The mean follow-up time was 2.2 years. For n=1144 of the included patients the presence respectively the absence of diabetes mellitus was documented. 8.0% (n=92) of these patients had the diagnosis of diabetes mellitus, from which 73.9% (n=68) were and 26.1% (n=24) were not under an antidiabetic therapy. Regarding the long-term outcome, patients without diabetes mellitus had significantly better results (log rank p=0.039). The according Kaplan-Meier-Analysis is shown in figure 1. Patients with diabetes mellitus were significantly older (69.5 years) when compared to patients without diabetes mellitus (63.1 years). However, when data was adjusted for age and gender, diabetes mellitus was still an independent, significant predictor of the recurrence of atrial fibrillation after pulmonary vein isolation. In addition, diabetics under an antidiabetic therapy had a significantly better long-term outcome than the untreated ones (log rank p=0.011). Figure 2 shows the according Kaplan-Meier-Analysis. Conclusion Diabetes mellitus has a significant influence on the long-term outcome of pulmonary vein isolation in patients with atrial fibrillation (log rank p=0.039). Patients without diabetes mellitus showed significantly better outcomes when compared to patients with diabetes mellitus also when adjusting the data for age and gender. Furthermore, the presence of an antidiabetic therapy in diabetics influences the long-term outcomes significantly (log rank p=0.011).