Surgical Ablation of Atrial Fibrillation in Diabetes Mellitus Patients: Real-World Data from the German Case AF Registry

Background: Diabetes mellitus is a risk factor for the development of atrial fibrillation. Metabolically induced atrial remodeling could negatively influence the rate of freedom from atrial fibrillation after surgical ablation. Metabolic diseases promote atrial fibrillation recurrences.

Methods: The Case AF Registry is a prospective, multicenter, all-comers registry of lone-standing and concomitant atrial ablation in cardiac surgery. We analyzed the 12-month outcome regarding survival, complications, and rhythm endpoints of 1,000 consecutive patients according to diabetic (DB) or non-diabetic (NDB) status.

Results: DB cases are more often male, older, and have an increased BMI. Paroxysmal, persistent and permanent AF occur equally with and without diabetes mellitus, but DB cases show significantly fewer symptoms (EHRA score I 30.1 vs. 14.2%; p < 0.001). There are no differences (DB versus NDB) in antiarrhythmic pretreatment and cardiac function (NYHA); however, LVEF is reduced in DB (LVEF < 40%: 20.1% versus 14.0%; p = 0.033). CABG procedures are performed twice as often in DB (56.7% versus 26.5%; p < 0.001), AV valve procedures significantly less (40.2% versus 63.8%; p < 0.001). CHA2DS2-Vasc score and HAS-BLED score do not differ. Comorbidities lead to a higher risk profile in DB (Euroscore II: 3.38 [2.04, 6.60] versus 2.34 [1.37, 4.44]; p < 0.001) without escalation of perioperative complications. Anticoagulation is primarily performed using DOAC in all patients; however, DB patients more often receive antiplatelet therapy (68.1% versus 47.7%; p < 0.001). LAA closure was complete in over 94% of patients. The line concepts used intraoperatively were identical, with diabetics receiving radiofrequency ablation more frequently (72.5% versus 50.9%; p < 0.001). Except for the use of AA class I in 3.1% of NDB (p = 0.013), there was no difference in antiarrhythmic therapy. DB and NDB showed identical rates of atrial fibrillation at discharge (61.1% versus 67.1%; p = 0.15), but in the interval up to 12 months in DB there was more freedom from recurrence (62.3% versus 55.2%; p = n.s) and fewer repeat cardioversions (6.3% versus 12.2%; p = 0.032). Despite the increased risk profile of DB, there are no TIAs or higher stroke rates after 12 months and different medications regarding anticoagulation or antiarrhythmic treatment.

Conclusion: Diabetes mellitus may be an initiator and perpetuator of cardiac remodeling. However, surgical ablation of AF in diabetic patients results in high ratios of freedom from AF without surgical risk escalation related to AF and reduction of AF-related symptoms. Diabetes mellitus should not lead to withholding an ablation procedure.

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Artikel online veröffentlicht:
11. Februar 2025