Safety and efficacy of catheter ablation of atrial fibrillation in patients with diabetes mellitus—single center experience Efficacy and safety of rivaroxaban in patients with diabetes and nonvalvular atrial fibrillation: the Rivaroxaban Once-daily, Oral, Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF Trial). Impact of intensive glycemic control on the incidence of atrial fibrillation and associated cardiovascular outcomes in patients with type 2 diabetes mellitus (from the Action to Control Cardiovascular Risk in Diabetes Study). Atrial fibrillation in patients with heart failure: Role of catheter ablation therapies. Long-term single procedure efficacy of catheter ablation of atrial fibrillation Rationale and Design of FIRE AND ICE: A multicenter randomized trial comparing efficacy and safety of pulmonary vein isolation using a cryoballoon versus radiofrequency ablation with 3D-reconstruction. One‐Year Outcome of Patients With Atrial Fibrillation Undergoing Coronary Artery Stenting: An Analysis of the AFCAS Registry Secular Trends, Treatments, and Outcomes of Middle Eastern Arab and South Asian Patients Hospitalized With Atrial Fibrillation Natural History and Long-Term Outcomes of Ablated Atrial Fibrillation Long-term efficacy and safety of two different rhythm control strategies in elderly patients with symptomatic persistent atrial fibrillation. Comparison of catheter ablation and surgical ablation in patients with long-standing persistent atrial fibrillation and rheumatic heart disease: a four-year follow-up study. Long-Term Improvement in Left Ventricular Strain After Successful Catheter Ablation for Atrial Fibrillation in Patients With Preserved Left Ventricular Systolic Function
Background and objective Little is known about the outcome of  catheter ablation of  atrial fibrillation ( AF )  in patients with diabetes mellitus ( DM ) . We investigated the safety and efficacy of catheter ablation of AF  in patients with DM . Material s and methods Thirty one patients with DM from a group of 263 consecutive patients undergoing a first-time catheter ablation of AF procedure  were enrolled in a prospect i ve study . The ablation protocol ( guided by CARTO system ) consisted in two continuous circular lesions around ipsilateral pulmonary veins . Results The following clinical characteristics differed between DM and no-DM patients : age ( 62.0 ± 10.8 vs. 56.1 ± 10.6 years , P = 0.004 ) , longer AF history ( 9.6 ± 9.3 vs. 6.7 ± 6.3 years , P = 0.024 ) , significantly larger left atrium size ( 41.1 ± 7.8 vs. 38.3 ± 5.8 mm , P = 0.021 ) , hypertension ( 58.1 vs. 35.8 % , P = 0.018 ) and structural heart disease ( 67.7 vs. 43.5 % , P = 0.011 ) . Despite a similar AF recurrence rate in DM and no-DM patients ( 32.3 vs. 22.4 % , P = 0.240 ) , the ablation procedure was complicated in 28 patients ( 11 hematomas , three cardiac tamponades and three strokes ) and the incidence of complications was significantly higher in DM than in no-DM patients ( 29.0 vs. 8.2 % , respectively , P = 0.002 ) . Multivariate analysis showed that DM was an independent risk factor for complications occurrence ( odd ratio 5.936 , 95 % confidence interval 2.059 to 17.112 , P = 0.001 ) . Conclusions First catheter ablation of AF procedure in DM patients was equally efficacious than in no-DM patients . However , DM patients had a higher incidence of complications , mostly thrombotic or hemorrhagic BACKGROUND The prevalence of both atrial fibrillation ( AF ) and diabetes mellitus ( DM ) are rising , and these conditions often occur together . Also , DM is an independent risk factor for stroke in patients with AF . We aim ed to examine the safety and efficacy of rivaroxaban vs warfarin in patients with nonvalvular AF and DM in a prespecified secondary analysis of the ROCKET AF trial . METHODS We stratified the ROCKET AF population by DM status , assessed associations with risk of outcomes by DM status and r and omized treatment using Cox proportional hazards models , and tested for interactions between r and omized treatments . For efficacy , primary outcomes were stroke ( ischemic or hemorrhagic ) or non- central nervous system embolism . For safety , the primary outcome was major or nonmajor clinical ly relevant bleeding . RESULTS The 5,695 patients with DM ( 40 % ) in ROCKET AF were younger , were more obese , and had more persistent AF  , but fewer had previous stroke  ( the CHADS2 score includes DM and stroke ) . The relative efficacy of  rivaroxaban and  warfarin for prevention of stroke and systemic embolism was similar in patients with ( 1.74 vs 2.14/100 patient-years , hazard ratio [ HR ] 0.82 ) and without ( 2.12 vs 2.32/100 patient-years , HR 0.92 ) DM ( interaction P = .53 ) . The safety of rivaroxaban vs warfarin regarding major bleeding ( HRs 1.00 and 1.12 for patients with and without DM , respectively ; interaction P = .43 ) , major or nonmajor clinical ly relevant bleeding ( HRs 0.98 and 1.09 ; interaction P = .17 ) , and intracerebral hemorrhage ( HRs 0.62 and 0.72 ; interaction P = .67 ) was independent of DM status . Adjusted exploratory analyses suggested 1.3- , 1.5- , and 1.9-fold higher 2-year rates of stroke , vascular mortality , and myocardial infa rct ion in DM patients . CONCLUSIONS AND RELEVANCE The relative efficacy and safety of rivaroxaban vs warfarin was similar in patients with and without DM , supporting use of rivaroxaban as an alternative to warfarin in diabetic patients with AF Atrial  fibrillation ( AF )  is prevalent in patients with type 2 diabetes mellitus ( DM ) and is associated with markers of poor glycemic control ; however , the impact of glycemic control on incident AF and outcomes is unknown . The aims of this study were to prospect ively evaluate if intensive glycemic control in patients with DM affects incident AF and to evaluate morbidity and mortality in patients with DM and incident AF . A total of 10,082 patients with DM from the Action to Control Cardiovascular Risk in Diabetes ( ACCORD ) cohort were studied in a r and omized , double-blind fashion . Participants were r and omized to an intensive therapeutic strategy targeting a glycated hemoglobin level of < 6.0 % or a st and ard strategy targeting a glycated hemoglobin level of 7.0 % to 7.9 % . Incident AF occurred in 159 patients ( 1.58 % ) over the follow-up period , at a rate of 5.9 per 1,000 patient-years in the intensive-therapy group and a rate of 6.37 per 1,000 patient-years in the st and ard-therapy group ( p = 0.52 ) . In a multivariate model , predictors of incident AF were age , weight , diastolic blood pressure , heart rate , and heart failure history .  Patients with DM and new-onset AF  had a hazard ratio of 2.65 for all-cause mortality ( 95 % confidence interval 1.8 to 3.86 , p < 0.0001 ) , a hazard ratio of 2.1 for myocardial infa rct ion ( 95 % confidence interval 1.33 to 3.31 , p = 0.0015 ) , and a hazard ratio of 3.80 for the development of heart failure ( 95 % confidence interval 2.48 to 5.84 , p < 0.0001 ) . In conclusion , intensive glycemic control did not affect the rate of new-onset AF .  Patients with DM and incident AF had an increased risk for morbidity and mortality compared with those without AF Atrial fibrillation ( AF ) represents the most common sustained cardiac arrhythmia in patients with heart failure ( HF ) . AF in HF patients is associated with worsening of symptoms and also results in a substantial increase in mortality . Although HF patients in sinus rhythm have a better outcome than patients with AF , several r and omized studies investigating pharmacological rhythm control versus rate control have shown no advantage of one strategy over the other in terms of patient outcomes . Catheter-based ablation therapy is a newer therapeutic option with a rapidly evolving and changing role in the management of this arrhythmia . In the present review , the authors discuss the epidemiology , pathophysiology and prognostic significance of AF in patients with HF . Exclusively addressed are studies investigating catheter-based ablation for rhythm-control and rate-control therapies in the management of AF in HF patients Background Two important limitations of the data regarding the outcomes of catheter ablation of atrial fibrillation ( AF ) are the short-term follow-up used in most published studies and the lack of single-procedure outcomes . Objective The objective was to report the long-term single-procedure outcomes at our center . Material s and methods The patient population was comprised of 200 consecutive patients who underwent ablation ( 133 men ; age 56 ± 11 years ) . Atrial fibrillation was paroxysmal in 92 ( 46 % ) . Success was defined as absence of symptomatic AF , off antiarrhythmic drug ( AAD ) after a single procedure . Results After a follow-up of 26 ± 11 months , the single-procedure long-term success rate was 28 % with an additional 7 % of patients demonstrating improvement . After including repeat procedures in 64 patients , the overall long-term success rate was 41 % with 11 % demonstrating improvement . Further subgroup analysis of 48 paroxysmal AF patients considered to be optimal c and i date s for the procedure , revealed a long-term success rate of 69 % with an additional 4 % demonstrating improvement . A major complication occurred in 7.9 % of patients . Conclusion The results reveal that the long-term single-procedure success rate  of catheter ablation of AF in a cohort of patients with predominantly non-paroxysmal AF is less than 40 % . The inclusion of redo procedures result ed in an improvement in outcomes . A much higher success rate of 69 % was achieved in patients with paroxysmal AF considered to be optimal c and i date s for this procedure . These results make it clear that further advances in the technique of catheter ablation of AF are needed to improve the safety and efficacy of this procedure . In order to be able to compare outcomes of various techniques in differing patient population s , we urge investigators to report long-term single procedure outcomes BACKGROUND Atrial fibrillation ( AF ) is the most common sustained cardiac arrhythmia imposing substantial morbidity and mortality . Catheter-based pulmonary vein isolation ( PVI ) using radiofrequency current ( RFC ) has become a st and ard treatment for drug-resistant and symptomatic paroxysmal AF ( PAF ) . In recent years , the cryoballoon-based technique is increasingly used as a promising alternative with a short learning curve . METHODS The FIRE AND ICE trial is a prospect i ve , r and omized , controlled , open , blinded outcome assessment , noninferiority trial comparing cryoballoon- , and RFC-based PVI .  Patients with drug-resistant PAF will be r and omized in a 1:1 matrix in multiple European centers . The primary hypothesis is that cryoballoon ablation is not inferior to RFC ablation using 3-dimensional mapping with respect to clinical efficacy . The primary endpoint is defined as the time to first documented clinical failure , including : ( 1 ) recurrence of AF ; ( 2 ) atrial flutter or atrial tachycardia ; ( 3 ) prescription of class I or III antiarrhythmic drugs ; or ( 4 ) re-ablation , whichever comes first , following a blanking period of 3 months after the index ablation procedure . The primary safety endpoint is a composite of death , stroke/transient ischemic attack , cardiac arrhythmias ( apart from AF recurrence ) causally related to the therapeutic intervention , and procedure-related serious adverse events . CONCLUSION The FIRE AND ICE trial compares 2 different technologies to perform catheter ablation of PAF with respect to efficacy and safety . It aims at providing objective data to guide selection and usage of ablation catheters in the treatment of AF Most evidence regarding the efficacy and safety of the antithrombotic regimens for patients with atrial fibrillation ( AF ) undergoing percutaneous coronary intervention with stent ( PCI‐S )  derives from small , single‐center , retrospective data sets . To obtain further data on this issue , we carried out the prospect i ve , multicenter , observational Management of patients with Atrial Fibrillation undergoing Coronary Artery Stenting ( AFCAS ) registry ( Clinical trials.gov identifier NCT00596570 ) A prospect i ve registry was made of all patients hospitalized with atrial fibrillation ( AF ) in the State of Qatar from 1991 to 2010 .  Clinical characteristics , management , and outcomes were compared according to ethnicity ( Middle Eastern Arab vs South Asian ) . During this 20-year period , 2857 Arabs and 548 Asians were hospitalized for AF . Arabs were 9 years older and more likely to have hypertension , diabetes mellitus ( DM ) , chronic renal impairment , and dyslipidemia than the Asians . Valvular heart disease and acute coronary syndromes were more common among Asians , while congestive heart failure was more common in Arabs . The overall inhospital mortality was lower in Asians than that of Arabs , while stroke rates were comparable . There was an increase in the prevalence of DM and hypertension in both the groups in the latter years of the study period , but there was no change in mortality trends . Our findings underscore the need to study AF according to ethnicity Background —Atrial  fibrillation ( AF ) ablation  is increasingly used in clinical practice . We aim ed to study the natural history and long-term outcomes of ablated AF . Methods and Results —We followed 831 patients after pulmonary vein isolation ( PVI ) performed in 2005 . We documented clinical outcomes using our prospect i ve AF registry with most recent up date on this group of patients in October 2009 . In the first year after ablation , 23.8 % had early recurrence . Over long-term follow-up ( 55 months ) , only 8.9 % had late arrhythmia recurrence defined as occurring beyond the first year after ablation . Repeat ablations in patients with late recurrence revealed conduction recovery in at least 1 of the previously isolated PVs in all of them and right-sided triggers with isoproterenol testing in 55.6 % . At last follow-up , clinical improvement was 89.9 % ( 79.4 % arrhythmia-free off antiarrhythmic drugs and 10.5 % with AF controlled with antiarrhythmic drugs ) . Only 4.6 % continued to have drug-resistant AF . It was possible to safely discontinue anticoagulation in a substantial proportion of patients with no recurrence in the year after ablation ( CHADS score ⩽2 , stroke incidence of 0.06 % per year ) . The procedure-related complication rate was very low . Conclusions —Pulmonary vein isolation is safe and efficacious for long-term maintenance of sinus rhythm and control of symptoms in patients with drug-resistant AF . It obviates the need for antiarrhythmic drugs , negative dromotropic agents , and anticoagulants in a substantial proportion of patients BACKGROUND We prospect ively compared the efficacy , safety , and quality of life ( QoL ) impact of catheter ablation versus antiarrhythmic drugs ( AAD ) in elderly patients with persistent atrial fibrillation ( AF ) . METHODS AND RESULTS Four hundred and twelve consecutive patients , aged ≥ 70 years , underwent ablation ( Group A , 153 patients ) or AAD ( Group B , 259 patients ) . Study endpoints : treatment failure ( any AF/AT lasting > 30 seconds ) and treatment-related adverse events ( acute when ≤1 month of procedure and long term when > 1 month ) . At a follow-up of 60 ± 17 months , 43 % and 46 % patients in Group B versus 58 % and 76 % in Group A were in sinus rhythm ( SR ) , respectively , after one ( P = 0.003 ) and 2 procedures ( P < 0.001 ) . Fifteen acute adverse events occurred ( 6.7 % in Group A vs 1 % in Group B , P < 0.001 ) , mainly periprocedural cerebral thromboembolism ( 3.3 % in Group A vs 0.7 % in Group B , P = 0.058 ) . Previous TIA/stroke result ed the only independent predictor of periprocedural cerebrovascular accidents ( OR 1.2 , 95%IC 1.1 - 1.3 ) . At follow-up , 74 long-term adverse events occurred ( 7.7 % in Group A vs 23.9 % in Group B , P < 0.001 ) with Group B patients more often experiencing  AAD-related  adverse events ( 12.7 % vs 2.6 % , P < 0.001 ) . Group A and absence of AF/AT recurrences significantly improved QoL scores ( P < 0.001 ) . CONCLUSIONS In elderly persistent AF patients  , catheter ablation is more effective in maintaining SR and in improving QoL  than AAD but is affected by a higher risk of embolic complications , particularly in patients with previous TIA/stroke . Over time , Group A patients more likely discontinued AAD with a reduction of long-term adverse events BACKGROUND In our previous prospect i ve and r and omized study , we have demonstrated that the concomitant surgical ablation using saline-irrigated cooled tip radiofrequency ablation ( SICTRA ) system is more effective than subsequent circumferential pulmonary vein isolation ( CPVI ) combined with substrate modification in treating patients with long-st and ing persistent atrial fibrillation ( LS-AF ) and rheumatic heart disease ( RHD ) undergoing cardiac surgery during middle-term follow-up . Whether this strategy also decreases longer-term arrhythmia recurrence is unknown . This study describes the 4-year efficacy of SICTRA for these patients . Furthermore , we seek to compare the electrophysiological characteristics for recurrent atrial tachyarrhythmia ( ATa ) at the session of catheter ablation between two groups . METHODS Long-term follow-up was performed in 95 patients who underwent the catheter ablation strategy ( n=47 , Group A ) or SICTRA ( n=48 , Group B ) combined with valvular surgery for symptomatic LS-AF patients with RHD . RESULTS After one procedure , Group B had a significantly higher freedom from ATa compared with Group A ( 29/48 vs 15/47 , P=0.005 ) after a mean follow-up of 54 months ( range 48 to 63 months ) . Catheter-based mapping and ablation of recurrent ATa showed larger amounts of macro-reentrant atrial tachycardias ( ATs ) in Group B and higher incidence of pulmonary vein ( PV ) recovery in Group A. After multiple catheter ablations for recurrent ATa , sinus rhythm ( SR ) could be maintained equally between two groups . CONCLUSIONS Single procedure success seems to be higher with SICTRA but repeated catheter ablation potentially results in comparable outcomes in treating patients with LS-AF and RHD during long-term follow-up . More macro-reentrant ATs and more PV recoveries are identified to be responsible for ATa in SICTRA and catheter ablation group , respectively Background —The effect of successful catheter ablation on left ventricular ( LV ) strain in patients with preserved LV systolic function is unknown . The aim of the present study was to assess the long-term effects of catheter ablation for atrial fibrillation ( AF )  on LV strain and strain rate in patients with preserved LV ejection fraction . Methods and Results —In 78 patients undergoing catheter ablation for AF  , speckle tracking strain imaging was performed to assess LV strain in 3 directions ( radial , circumferential , and longitudinal ) at baseline and after 12-month follow-up . The study population was divided into 2 groups , according to the maintenance of sinus rhythm ( SR ) during follow-up . After 13.8±4.7 months of follow-up , 54 patients ( 69 % ) were in SR ( SR group ) , whereas 24 patients ( 31 % ) had recurrence of AF ( AF group ) . No significant changes in LV ejection fraction from baseline to follow-up were noted ( 60±7 % versus 59±7 % , P = NS ) . Circumferential strain improved significantly in the SR group ( −18.3±3.2 % versus −20.4±3.8 % , P<0.001 ) , whereas it remained unchanged in the AF group ( −18.9±3.5 % versus −17.9±3.1 % , P = NS ) . In the SR group , significant improvements in LV longitudinal strain and strain rate were noted , whereas in the AF group , LV longitudinal strain and strain rate deteriorated significantly at long-term follow-up . Conclusions —After successful catheter ablation , LV circumferential and longitudinal strain and strain rate improve significantly in patients who maintain SR . In contrast , a decrease in LV longitudinal strain and strain rate is observed in patients with recurrence of AF
Catheter ablation of AF  safety and efficacy in DM patients is similar to general population , especially when performed in younger patients with satisfactory glycemic control .
Catheter ablation of AF reduces the amount of patients requiring AADs , an additional benefit in this population commonly exposed to adverse effects of AF pharmacological treatments
AIMS Diabetes mellitus ( DM ) and atrial fibrillation ( AF ) share pathophysiological links , as supported by the high prevalence of AF within DM patients .
Catheter ablation of AF ( AFCA ) is an established therapeutic option for rhythm control in drug resistant symptomatic patients .
Its efficacy and safety among patients with DM is based on small population s , and long-term outcome is unknown .
The present systematic review and meta- analysis aims to assess safety and long-term outcome of AFCA in DM patients , focusing on predictors of recurrence .