Diabetes linked to stiff LA physiology with worse rhythm outcomes after AF catheter ablation: Study
South Korea: A stiff left atrium (LA) physiology after AF catheter ablation (AFCA) is independently associated with diabetes mellitus due to the relatively small reduction in the pulmonary vascular resistance after AFCA, a recent study has stated. The patients with stiff LA physiology had worse rhythm outcomes versus those without it.
The formation of scar tissue after catheter ablation for atrial fibrillation (AF) may negatively impact the diastolic properties of the LA. This can result in stiff LA physiology in a small proportion of patients. In the study, published in the journal Frontiers in Cardiovascular Medicine, Moon-Hyun Kim, Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, South Korea, and colleagues aimed to explore the relationship between diabetes mellitus and a stiff LA physiology after AF catheter ablation.
For this purpose, the researchers enrolled a total of 1,326 patients who underwent de novo AFCA, and baseline and 1-year follow-up echocardiographic. They compared 211 patients with DM with 633 patients without DM after a 1:3 propensity score (PS) matching for age, sex, and AF type.
A stiff LA physiology was defined as an estimated pulmonary arterial pressure increase of >10 mmHg and a right ventricular systolic pressure of >35 mmHg at 1-year follow-up echocardiography. Echocardiographic parameters were used for estimating pulmonary vascular resistance.
The findings of the study were as follows:
· Among the 844 PS-matched patients, a stiff LA physiology was observed in 4.1% of patients.
· The patients with DM showed a higher peak LA pressure and greater LA wall stress than did those without.
· A stiff LA physiology was independently associated with DM [Odds ratio (OR) = 2.39], empirical extra-pulmonary vein LA ablation (OR = 3.14) and the ΔPVR (OR = 1.78).
· The ΔPVR was independently associated with DM (β = 0.37) and a stiff LA physiology (β = 1.40).
· During the 38.8 ± 29.3months follow-up, the incidence of the clinical recurrence of AF was significantly higher in the patients with a stiff LA physiology than in those without.
"Our findings showed that a stiff LA physiology is independently associated with DM because of the relatively small decrease in the PVR after AFCA in this population," the authors wrote in their study. "The patients with a stiff LA physiology had worse rhythm outcomes after AFCA than those without."
Reference:
Kim M-H, Yu HT, Park YJ, Kim T-H, Joung B, Lee M-H and Pak H-N (2022) Diabetes Mellitus Is an Independent Risk Factor for a Stiff Left Atrial Physiology After Catheter Ablation for Atrial Fibrillation. Front. Cardiovasc. Med. 9:828478. doi: 10.3389/fcvm.2022.828478
