Left atrial low-voltage areas (LVAs) are known to be correlated with atrial scarring and atrial fibrillation (AF) recurrence after ablation. However, the association between LVAs and glycemic status before ablation has not been fully clarified. The purpose of this study was to investigate associations among the prevalence of diabetes mellitus (DM), glycemic control, and the prevalence of LVAs in patients with AF ablation.

Methods

In total, 912 (age, 68 ± 10 years; female, 299 [33%]; persistent AF, 513 [56%]) consecutive patients who underwent initial AF ablation were included. A preprocedure glycated hemoglobin A1c (HbA1c) ≥7% was set as the cutoff for poor glycemic control in patients with DM. LVAs were defined as areas with a bipolar voltage of <0.5 mV covering ≥5 cm² of left atrium.

Results

LVAs existed in 208 (23%) patients, and 168 (18%) patients had DM. LVAs were found more frequently in patients with DM and poor glycemic control. On multivariate analysis, DM with HbA1c ≥7% was an independent predictor of LVAs (odds ratio, 3.3; 95% confidence interval: 1.6–6.7; p = .001). In patients with LVAs, freedom from AF recurrence during the 24-month study period was significantly lower in patients who had DM with HbA1c ≥7% than in those without DM (37.9% vs. 54.7%, p = .02).

Conclusion

In patients with AF ablation, LVAs were found more frequently in patients with DM and poor glycemic control. DM with HbA1c ≥7% was an independent predictor of LVAs.

REFERENCES

1Nogami A, Kurita T, Abe H, et al. JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias. Circ J. 2021; 85: 1104-1244.
10.1253/circj.CJ-20-0637
CAS PubMed Web of Science® Google Scholar
2Araki E, Goto A, Kondo T, et al. Japanese clinical practice guideline for diabetes 2019. Diabetol Int. 2020; 11: 165-223.
10.1007/s13340-020-00439-5
PubMed Web of Science® Google Scholar
3Donnellan E, Aagaard P, Kanj M, et al. Association between pre-ablation glycemic control and outcomes among patients with diabetes undergoing atrial fibrillation ablation. JACC Clin Electrophysiol. 2019; 5: 897-903.
10.1016/j.jacep.2019.05.018
PubMed Google Scholar
4Yamaguchi T, Otsubo T, Takahashi Y, et al. Atrial structural remodeling in patients with atrial fibrillation is a diffuse fibrotic process: evidence from high-density voltage mapping and atrial biopsy. J Am Heart Assoc. 2022; 11:e024521.
10.1161/JAHA.121.024521
PubMed Web of Science® Google Scholar
5Verma A, Wazni OM, Marrouche NF, et al. Pre-existent left atrial scarring in patients undergoing pulmonary vein antrum isolation: an independent predictor of procedural failure. J Am Coll Cardiol. 2005; 45: 285-292.
10.1016/j.jacc.2004.10.035
PubMed Web of Science® Google Scholar
6Masuda M, Fujita M, Iida O, et al. Left atrial low-voltage areas predict atrial fibrillation recurrence after catheter ablation in patients with paroxysmal atrial fibrillation. Int J Cardiol. 2018; 257: 97-101.
10.1016/j.ijcard.2017.12.089
PubMed Web of Science® Google Scholar
7Matsuda Y, Masuda M, Asai M, et al. A new clinical risk score for predicting the prevalence of low-voltage areas in patients undergoing atrial fibrillation ablation. J Cardiovasc Electrophysiol. 2020; 31: 3150-3158.
10.1111/jce.14761
PubMed Web of Science® Google Scholar
8Kosiuk J, Dinov B, Kornej J, et al. Prospective, multicenter validation of a clinical risk score for left atrial arrhythmogenic substrate based on voltage analysis: DR-FLASH score. Heart Rhythm. 2015; 12: 2207-2212.
10.1016/j.hrthm.2015.07.003
PubMed Web of Science® Google Scholar
9Cosentino F, Grant PJ, Aboyans V, et al. 2019 ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2020; 41: 255-323.
10.1093/eurheartj/ehz486
PubMed Web of Science® Google Scholar
10ElSayed NA, Aleppo G, Aroda VR, et al. 6. Glycemic targets: standards of care in diabetes—2023. Diabetes Care. 2023; 46: S97-S110.
10.2337/dc23-S006
PubMed Web of Science® Google Scholar
11Reissmann B, Wissner E, Deiss S, et al. First insights into cryoballoon-based pulmonary vein isolation taking the individual time-to-isolation into account. Europace. 2017; 19: 1676-1680.
10.1093/europace/euw233
PubMed Web of Science® Google Scholar
12Gherasim L. Association of atrial fibrillation with diabetes mellitus, high risk comorbidities. Maedica (Bucur). 2022; 17: 143-152.
PubMed Google Scholar
13Goette A, Lendeckel U. Atrial cardiomyopathy: pathophysiology and clinical consequences. Cells. 2021; 10: 2605.
10.3390/cells10102605
CAS PubMed Web of Science® Google Scholar
14Rosa CM, Xavier NP, Henrique Campos D, et al. Diabetes mellitus activates fetal gene program and intensifies cardiac remodeling and oxidative stress in aged spontaneously hypertensive rats. Cardiovasc Diabetol. 2013; 12: 152.
10.1186/1475-2840-12-152
PubMed Web of Science® Google Scholar
15Tadic M, Cuspidi C. The influence of type 2 diabetes on left atrial remodeling. Clin Cardiol. 2015; 38: 48-55.
10.1002/clc.22334
CAS PubMed Web of Science® Google Scholar
16Wang Q, Wang J, Wang P, et al. Glycemic control is associated with atrial structural remodeling in patients with type 2 diabetes. BMC Cardiovasc Disord. 2019; 19: 278.
10.1186/s12872-019-1249-2
CAS PubMed Web of Science® Google Scholar
17Anderson EJ, Kypson AP, Rodriguez E, Anderson CA, Lehr EJ, Neufer PD. Substrate-specific derangements in mitochondrial metabolism and redox balance in the atrium of the type 2 diabetic human heart. J Am Coll Cardiol. 2009; 54: 1891-1898.
10.1016/j.jacc.2009.07.031
CAS PubMed Web of Science® Google Scholar
18Zhang X, Zhang Z, Zhao Y, et al. Alogliptin, a dipeptidyl Peptidase-4 inhibitor, alleviates atrial remodeling and improves mitochondrial function and biogenesis in diabetic rabbits. J Am Heart Assoc. 2017; 6:e005945.
10.1161/JAHA.117.005945
PubMed Web of Science® Google Scholar
19Karam BS, Chavez-Moreno A, Koh W, Akar JG, Akar FG. Oxidative stress and inflammation as central mediators of atrial fibrillation in obesity and diabetes. Cardiovasc Diabetol. 2017; 16: 120.
10.1186/s12933-017-0604-9
PubMed Web of Science® Google Scholar
20Shan J, Xie W, Betzenhauser M, et al. Calcium leak through ryanodine receptors leads to atrial fibrillation in 3 mouse models of catecholaminergic polymorphic ventricular tachycardia. Circ Res. 2012; 111: 708-717.
10.1161/CIRCRESAHA.112.273342
CAS PubMed Web of Science® Google Scholar
21Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: executive summary. Europace. 2018; 20: 157-208.
10.1093/europace/eux275
PubMed Web of Science® Google Scholar
22Yahaya JJ, Doya IF, Morgan ED, Ngaiza AI, Bintabara D. Poor glycemic control and associated factors among patients with type 2 diabetes mellitus: a cross-sectional study. Sci Rep. 2023; 13: 9673.
10.1038/s41598-023-36675-3
CAS PubMed Web of Science® Google Scholar
23Sawada M, Otsuka N, Nagashima K, et al. Clinical implication of the patient's disease awareness and adherence to medications in patients undergoing atrial fibrillation ablation. J Arrhythmia. 2023; 40: 57-66.
10.1002/joa3.12965
PubMed Web of Science® Google Scholar

Citing Literature

Volume35, Issue4

April 2024

Pages 775-784

Impact of diabetes mellitus and poor glycemic control on the prevalence of left atrial low-voltage areas and rhythm outcome in patients with atrial fibrillation ablation

Abstract

Introduction

Methods

Results

Conclusion

REFERENCES

Citing Literature

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

Impact of diabetes mellitus and poor glycemic control on the prevalence of left atrial low-voltage areas and rhythm outcome in patients with atrial fibrillation ablation

Abstract

Introduction

Methods

Results

Conclusion

REFERENCES

Citing Literature

References

Related

Information