Pathophysiologic Characteristics and Clinical Outcomes of Catheter Ablation in Patients with Atrial Fibrillation Associated with Diabetes

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Background: The left atrial (LA) remodeling is related to the clinical outcome and the risk of stroke in patients with atrial fibrillation (AF) who underwent radiofrequency catheter ablation (RFCA). We hypothesized that the LA remodeling and clinical outcome of RFCA are different in patients with AF associated with diabetes (DM), which is a risk factor for stroke. Methods and Results: We included 530 patients with AF who underwent RFCA, and compared imaging parameters and pro-ANP and TGF-β plasma between patients with DM (n=54) and without DM (n=476). 1. DM group was older (p<0.0001) and had higher CHADS2 scores (p<0.0001), higher proportions of previous stroke (p=0.0134) or hypertension (p<0.0001) than non-DM group. 2. DM group had greater LA diameter (p=0.0396) with higher E/E, (p=0.0045), LA pressure (p=0.0200), and pro-ANP (p=0.0096), but lower TGF-β (p=0.0043) than non-DM group. 3. Although peri-procedural complication rates (1.85% vs. 1.68%, p=0.4641) and recurrence rates (18.37% vs. 16.75%, p=0.3874) were similar between two groups, the early recurrence rate was rather lower (22.45% vs. 35.61%, p=0.0331) in DM group than in non-DM group. Conclusion: Despite more advanced LA remodeling related to diastolic dysfunction and atrial hemodynamic overload in patients with AF and DM, the peri-procedural complication and clinical recurrence rates were comparable to patients without DM after RFCA.