Arrhythmias and conduction disturbances
Atrial Substrate Properties and Outcome of Catheter Ablation in Patients With Paroxysmal Atrial Fibrillation Associated With Diabetes Mellitus or Impaired Fasting Glucose

https://doi.org/10.1016/j.amjcard.2010.07.038Get rights and content

Diabetes mellitus has been reported to be an independent risk factor of atrial fibrillation (AF). The present study investigated the atrial substrate properties and clinical outcome of catheter ablation in patients with paroxysmal AF and abnormal glucose metabolism. A total of 228 patients with paroxysmal AF who had undergone catheter ablation for the first time were enrolled. An abnormal glucose metabolism (n = 65) was defined as diabetes mellitus or an impaired fasting glucose. We analyzed the clinical and electrophysiologic characteristics in, and the clinical outcome of, patients with AF with and without an abnormal glucose metabolism. The right atrial (107.2 ± 15.4 vs 96.0 ± 16.5 ms, p <0.001) and left atrial (108.4 ± 22.3 vs 94.0 ± 17.5 ms, p <0.001) total activation times were significantly longer in the patients with AF and an abnormal glucose metabolism than in those without an abnormal metabolism. Furthermore, the right atrial (1.46 ± 0.61 vs 2.00 ± 0.70 mV, p <0.001) and left atrial (1.48 ± 0.74 vs 2.05 ± 0.78 mV, p <0.001) bipolar voltages were significantly lower in those with AF and an abnormal glucose metabolism than in those without. The AF recurrence rate was also greater in the patients with an abnormal glucose metabolism (18.5% vs 8.0%, p = 0.022) than in those without. The follow-up duration was 18.8 ± 6.4 months. In conclusion, an abnormal glucose metabolism affects the biatrial substrate properties with an intra-atrial conduction delay, decreased voltage, and greater recurrence rate after catheter ablation.

Section snippets

Methods

Bi-atrial electroanatomic mapping using a 3-dimensional mapping system (NavX, St. Jude Medical, St. Paul, Minnesota) was performed in 228 consecutive patients (age 52.3 ± 12.6 years, 167 men) with symptomatic drug-refractory paroxysmal AF. An abnormal glucose metabolism was defined as DM or an impaired fasting glucose, which was diagnosed according to the American Diabetes Association criteria.11 A total of 65 patients (28.5% of the study population) were included in the abnormal glucose

Results

The baseline characteristics of the study patients are listed in Table 1. The mean age of the study population was 52.3 ± 12.6 years (range 20 to 85). Of the 228 patients, 167 were men and 61 were women. Of the study population, 29% had hypertension, 14% dyslipidemia, and 20% coronary artery disease. The AF duration was 4.5 ± 4.0 years. No significant differences were found in the distribution of men, underlying disease, medications used, lipid profile, or AF duration between the 2 groups. The

Discussion

In the present study, we investigated the electrophysiologic properties of the biatrial substrate and outcome after catheter ablation in patients with paroxysmal AF and a normal or an abnormal glucose metabolism. To the best of our knowledge, this study is the first to investigate the relation between an abnormal glucose metabolism and the atrial substrate. The main findings were as follows. First, patients with an abnormal glucose metabolism, including those with DM and those with an impaired

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    Drs. Tze-Fan Chao and Kazuyoshi Suenari contributed equally to their work.

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