Impact of Glycemic Control on AF Ablation

Aug 22, 2019
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Authors:
Donnellan E, Aagaard P, Kanj M, et al.
Citation:
Association Between Pre-Ablation Glycemic Control and Outcomes Among Patients With Diabetes Undergoing Atrial Fibrillation Ablation. JACC Clin Electrophysiol 2019;5:897-903.
Summary By:
Fred Morady, MD, FACC

Study Questions:

Does the degree of glycemic control in patients with diabetes influence the outcome of catheter ablation (CA) of atrial fibrillation (AF)?

Methods:

In this retrospective cohort study, CA of AF (persistent in 59%) was performed in 298 patients with diabetes (mean age, 66.6 years; type 2 diabetes in 88%). The patients were divided into three categories of glycemic control based on serial measurements of glycated hemoglobin (HbA1c) during the 12 months before CA.

Results:

Recurrent AF occurred in 133 patients (44.6%) during a mean follow-up of 26 months. The AF recurrence rates were 32.4%, 53.4%, and 68.8% among the patients with an HbA1c <7%, 7-9%, and >9%, respectively. The recurrence rate was 91% among the patients in whom glycemic control worsened during the 12 months before ablation, compared to 2% among the patients whose HbA1c improved by >10% during the same time period. After adjustment for multiple potential confounding variables, an improvement or worsening in HbA1c during the 12 months before CA remained independent predictors of a lower or higher AF recurrence rate, respectively.

Conclusions:

The 12-month trend in glycemic control in patients with diabetes undergoing CA of AF is a significant predictor of outcome.

Perspective:

Prior studies have established that risk factor modification, including weight loss, optimal treatment of hypertension and sleep apnea, and glycemic control, reduces the risk of recurrent AF after CA of AF. An important contribution of the present study is the finding that the trend in HbA1c during the year before CA is more predictive of outcome than the HbA1c at the time of CA. This suggests that optimal management of diabetes prior to CA may lower the risk of recurrent AF.

Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Blood Glucose, Catheter Ablation, Diabetes Mellitus, Type 2, Hemoglobin A, Hypertension, Outcome Assessment, Health Care, Primary Prevention, Recurrence, Risk Factors, Sleep Apnea, Obstructive, Weight Loss


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