https://doi.org/10.1007/s00392-025-02625-4
Bernd Niemann (Gießen)1, N. Doll (Bad Rothenfelde)2, H. Grubitzsch (Berlin)3, T. Hanke (Hamburg)4, J. Senges (Ludwigshafen am Rhein)5, T. Ouarrak (Ludwigshafen am Rhein)6, M. Vondran (Rotenburg an der Fulda)7, S. Rohrbach (Gießen)8, A. Böning (Gießen)1
1Universitätsklinikum Gießen und Marburg GmbH
Klinik für Herz-, Kinderherz- und Gefäßchirurgie
Gießen, Deutschland; 2Schüchtermann-Klinik Bad Rothenfelde
Herzchirurgie
Bad Rothenfelde, Deutschland; 3Charité – Universitätsmedizin Berlin
Herzchirurgie
Berlin, Deutschland; 4Asklepios Klinikum Harburg
I. Medizinische Abteilung, Kardiologie
Hamburg, Deutschland; 5Stiftung Institut für Herzinfarktforschung
Ludwigshafen am Rhein, Deutschland; 6IHF GmbH Institut für Herzinfarktforschung, Ludwigshafen am Rhein, Deutschland
IHF GmbH Institut für Herzinfarktforschung, Ludwigshafen am Rhein, Deutschland
Ludwigshafen am Rhein, Deutschland; 7Herz-Kreislauf-Zentrum, Klinikum Hersfeld-Rotenburg GmbH
Rotenburg an der Fulda, Deutschland; 8Justus-Liebig-Universität Giessen
Physiologisches Institut
Gießen, Deutschland
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 lonestanding and concomitant atrial ablation in cardiac surgery. We analyzed the 12-months outcome regarding survival, complications and rhythm endpoints of 1000 consecutive patients according to diabetic (DB) or non-diabetic (NDB) status.
Results
DB are more often male, older and have an increased BMI. Paroxysmal, persistent and permanent AF occur equally with and without diabetes mellitus, but DB show significantly fewer symptoms (EHRA score I 30.1&vs 14.2%; p<0.001). There are no differences (DB vs.NDB) in antiarrhythmic pretreatment and cardiac function (NYHA), however, LVEF is reduced in DB (LVEF<40%: 20.1% vs. 14.0%; p=0.033).
CABG procedures are performed twice as often in DB (56.7% vs. 26.5%; p < 0.001), AV valve procedures significantly less (40.2% vs. 63.8%; p < 0.001).
CHA2DS2-Vasc score and HAS-BLED score do not differ. Co-morbidities lead to a higher risk profile in DB (Euroscore II: 3.38 (2.04, 6.60) vs. 2.34 (1.37, 4.44); p< 0.001) without escalation of perioperative complications. Anticoagulation is primarily carried out using DOAC in all patients; however, DB more often receive antiplatelet therapy (68.1% vs. 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% vs. 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% vs. 67.1%: p = 0.15), but in the interval up to 12 months in DB there was more freedom from recurrence (62.3% vs. 55.2%; p = n.s) and fewer repeat cardioversions (6.3% vs. 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.