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HbA1c levels as predictors of ablation outcome in type 2 diabetes mellitus and paroxysmal atrial fibrillation

HbA1c-Wert als Prädiktor für das Ergebnis der Ablation bei Diabetes mellitus Typ 2 und paroxysmalem Vorhofflimmern

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Abstract

Aims

The aim of this study was to evaluate whether the levels of HbA1c could predict the outcome of ablation in patients with type 2 diabetes mellitus (T2DM) and paroxysmal atrial fibrillation (PAF).

Patients and methods

The study comprised 149 consecutive patients with T2DM and PAF who underwent their first circumferential pulmonary vein isolation. HbA1c levels were measured before ablation. Cox proportional hazards models were constructed to assess the relationship between HbA1c levels and the recurrence of atrial fibrillation (AF).

Results

Of the 149 patients, 60 (40.3 %) developed AF recurrence after a median 12-month follow-up. Multivariate Cox regression analysis revealed that left atrium size and HbA1c were independent predictors of recurrent atrial tachyarrhythmia. Receiver operating characteristic analysis demonstrated that an HbA1c cut-off value of ≥ 6.9 % predicted recurrence with 55.0 % sensitivity and 67.4 % specificity (AUC = 0.634). The success rate of ablation was 69.0 % in patients with an HbA1c value of < 6.9 % compared with 46.8 % in those with an HbA1c value of ≥ 6.9 % (log-rank test, p = 0.004).

Conclusion

High levels of HbA1c were associated with an increased risk of recurrence of atrial tachyarrhythmia in patients with T2DM and PAF undergoing catheter ablation.

Zusammenfassung

Ziel

Ziel der vorliegenden Studie war zu untersuchen, ob der HbA1c-Wert das Ergebnis der Ablation bei Patienten mit Diabetes mellitus Typ 2 (T2DM) und paroxysmalem Vorhofflimmern (PAF) prognostizieren konnte.

Patienten und Methoden

In die Studie aufgenommen wurden 149 konsekutive Patienten mit T2DM und PAF, bei denen erstmals eine zirkumferenzielle Pulmonalvenenisolation erfolgte. Vor Ablation wurde der HbA1c-Wert bestimmt. Um den Zusammenhang zwischen HbA1c-Wert und einem Rezidiv des Vorhofflimmerns (AF) zu erfassen, wurden Proportional-Hazard-Modelle nach Cox erstellt.

Ergebnisse

Bei 60 (40,3 %) der 149 Patienten trat nach einer durchschnittlichen Nachbeobachtungsdauer von 12 Monaten ein VF-Rezidiv auf. Die multivariate Cox-Regressionsanalyse ergab, dass die Größe des linken Vorhofs und der HbA1c-Wert unabhängige Prädiktoren einer rezidivierenden Vorhoftachyarrhythmie waren. Die Receiver-operating-characteristics-Analyse zeigte, dass ein HbA1c-Grenzwert ≥ 6,9 % ein Rezidiv mit einer Sensitivität von 55,0 % und einer Spezifität von 67,4 % (Fläche unter der Kurve, AUC = 0,634) prognostizierte. Die Erfolgsrate der Ablation betrug 69,0 % bei Patienten mit einem HbA1c < 6,9 % gegenüber 46,8 % bei Patienten mit einem HbA1c ≥ 6,9 % (Log-Rank-Test, p = 0,004).

Schlussfolgerung

Hohe HbA1c-Werte gingen bei Patienten mit T2DM und PAF, bei denen eine Katheterablation erfolgte, mit einem erhöhten Rezidivrisiko für eine Vorhoftachyarrhythmie einher.

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Acknowledgments

This work was supported by the National Key Basic Research Program of China (973 program, no. 2013CB531105), a Beijing cardiovascular clinical data and sample repository development and application (no. D131100002313001), and a China arrhythmia registration study (C-rhythm, no. 2013BAI09B02), the National Natural Science Foundation of China (no. 81200141).

Compliance with ethical guidelines

Conflict of interest. Z.-H. Lu, N. Liu, B. Rai, Y. Yao, S.-N. Li, R.-H. Yu, C.-H. Sang, R.-B. Tang, D.-Y. Long, X. Du, J.-Z. Dong, and C.-S. Ma state that there are no conflicts of interest. All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

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Authors and Affiliations

  1. Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, 100029, Beijing, Chaoyang District, P.R. China

    Z.-H. Lu, N. Liu, R. Bai, Y. Yao, S.-N. Li, R.-H. Yu, C.-H. Sang, R.-B. Tang, D.-Y. Long, X. Du, J.-Z. Dong & C.-S. Ma MD, PhD

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  1. Z.-H. Lu
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  2. N. Liu
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  3. R. Bai
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  10. X. Du
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  11. J.-Z. Dong
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  12. C.-S. Ma MD, PhD
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Correspondence to C.-S. Ma MD, PhD.

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Lu, ZH., Liu, N., Bai, R. et al. HbA1c levels as predictors of ablation outcome in type 2 diabetes mellitus and paroxysmal atrial fibrillation. Herz 40 (Suppl 2), 130–136 (2015). https://doi.org/10.1007/s00059-014-4154-6

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  • DOI: https://doi.org/10.1007/s00059-014-4154-6

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