P834Catheter ablation of persistent atrial fibrillation in type 2 diabetes mellitus patients with implanted cardiac pacemaker

Abstract

Objective: Patients with comorbidity are common in clinical practice. In current recommendations, there is lack of information regarding the efficacy and the advisability of radiofrequency ablation (RFA) of atrial fibrillation (AF) in complex cohort of patients with various diseases potentially affecting the outcomes of catheter intervention. The aim of our study was to investigate the efficacy of catheter treatment in type 2 diabetes mellitus (T2D) patients with AF and sick sinus syndrome (SSS) corrected by cardiac pacemaker implantation. Materials and Methods. The study comprised 41 patients (24 females) with persistent AF and SSS mean age of patients was 67.4612.3 years. Mean duration of AF history was 4.661.8 years. Following examination, a dual chamber cardiac pacemaker with remote monitoring function was implanted to all patients. All patients received antiarrhythmic therapy. Patients were assigned to two groups: group 1 comprised 22 patients aged 62.2612.1 years including nine T2D patients (41%) group 2 comprised 19 patients aged 73.469.6 years including nine T2D patients (47.3%). Patients of group 1 received RFA of the pulmonary vein ostia and the left atrial posterior wall after cardiac pacemaker implantation. Patients of group 2 received antiarrhythmic drug therapy. Results: Telemonitoring data showed that the efficacy rate of AF RFA was 55% in group 1 where symptom-free AF paroxysms with duration of up to one hour were observed in 25% of patients. In group 2, 21% of patients did not have AF paroxysms for one year (2=4.81, h=0.028). Other patients of group 2 had prolonged AF paroxysms; 40% of patients required adjustment of drug treatment due to frequent paroxysms. The rates of hospitalization for AF were 11% and 52%, respectively (2=9.34, h=0.002). The efficacy rate of AF RFA in T2D patients in group 1 was also 55% (2=0.07, h=0.78). The ventricular stimulation rates in both groups did not significantly differ and were 21.4615.2% and 24.5612.2%, respectively (h=0.48). One patient had post puncture femoral hematoma as a complication of RFA procedure (2.4%). Conclusion: Results of catheter treatment in patients with persistent form of AF associated with SSS corrected by cardiac pacemaker implantation suggested the high efficacy and safety of this method and confirmed its superiority compared to pharmacological approach. The presence of T2D likely did not significantly affect the efficacy of RFA for persistent form of AF.