Association of diabetes with atrial fibrillation types: a systematic review and meta-analysis

Abstract

Background Atrial fibrillation (AF) is a common arrhythmia classified as paroxysmal and non-paroxysmal. Non-paroxysmal AF is associated with an increased risk of complications. Diabetes contributes to AF initiation, yet its role in AF maintenance is unclear. We conducted a systematic review and meta-analysis to summarize the evidence regarding the association of diabetes with AF types. Methods We searched 5 databases for observational studies investigating the association of diabetes with the likelihood of an AF type (vs another type) in humans. Study quality was evaluated using the Newcastle–Ottawa Scale. Studies classifying AF types as paroxysmal (reference) and non-paroxysmal were pooled in a meta-analysis using random effects models. Results Of 1997 articles we identified, 20 were included in our systematic review. The population sample size ranged from 64 to 9816 participants with mean age ranging from 40 to 75 years and percentage of women from 24.8 to 100%. The quality of studies varied from poor (60%) to fair (5%) to good (35%). In the systematic review, 8 studies among patients with AF investigated the cross-sectional association of diabetes with non-paroxysmal AF (vs paroxysmal) of which 6 showed a positive association and 2 showed no association. Fourteen studies investigated the longitudinal association of diabetes with “more sustained” AF types (vs “less sustained”) of which 2 showed a positive association and 12 showed no association. In the meta-analysis of cross-sectional studies, patients with AF and diabetes were 1.31-times more likely to have non-paroxysmal AF than those without diabetes [8 studies; pooled OR (95% CI), 1.31 (1.13–1.51), I2 = 82.6%]. The meta-analysis of longitudinal studies showed that for patients with paroxysmal AF, diabetes is associated with 1.32-times increased likelihood of progression to non-paroxysmal AF [five studies; pooled OR (95% CI), 1.32 (1.07–1.62); I2 = 0%]. Conclusions Our findings suggest that diabetes is associated with an increased likelihood of non-paroxysmal AF rather than paroxysmal AF. However, further high quality studies are needed to replicate these findings, adjust for potential confounders, elucidate mechanisms linking diabetes to non-paroxysmal AF, and assess the impact of antidiabetic medications on AF types. These strategies could eventually help decrease the risk of non-paroxysmal AF among patients with diabetes.

The Cardiac-Kidney-Liver (CKL) syndrome: the “real entity” of type 2 diabetes mellitus

“…T2DM has also been linked to arrythmias (e.g., atrial fibrillation (AF)) [ 16 , 17 ] and sudden cardiac death (SCD) [ 18 ]. Regarding AF, a previous meta-analysis including 8 cross-sectional studies ( n = 39,898 participants) showed that patients with diabetes had a 1.31-times higher likelihood of having non-paroxysmal rather than paroxysmal AF (pooled OR = 1.31, 95% CI: 1.13–1.51, I 2 = 82.6%) [ 19 ]. Furthermore, another meta-analysis found that both prediabetes (RR = 1.20, 95% CI: 1.03–1.39, I 2 = 30%; n = 42,392 cases, 58,547 participants) and diabetes (RR = 1.28, 95% CI: 1.22–1.35, I 2 = 90%; n = 31,249,772 cases, 10,244,043 participants) were linked to an increased risk for AF [ 20 ].…”

The Synergistic Relationship Between Atrial Fibrillation and Diabetes Mellitus: Implications for Cardiovascular and Metabolic Health

“…Furthermore, Alijla et al's systematic review and meta-analysis, which included eight cross-sectional and 14 longitudinal studies, highlighted that diabetes increased the AF risk by 39% in cross-sectional studies and 28% in longitudinal studies [ 22 ]. The study by Seyed Ahmadi et al was a cohort study of 421,855 patients with T2DM and 2,131,223 controls [ 23 ].…”

Glycemic control and atrial fibrillation: an intricate relationship, yet under investigation

“…Furthermore, the magnitude of association varies between DM and AF types; persistent or permanent AF is the most prevalent type in diabetic populations, according to a recent meta-analysis of 20 relevant studies [7]. The presence of DM may also enhance progression from paroxysmal to persistent AF [7,25]. Moreover, the subjective symptoms of AF may be masked by DMassociated neuropathy and, therefore, delay diagnosis and treatment [26][27][28].…”

“…Although the epidemiology and implications of the AF and DM comorbidity seem to be well described in the current literature [ 6 , 7 ], the precise underlying pathogenic mechanisms still remain an issue of debate [ 8 ]. Significant questions also remain regarding the effect of glycemic control on the development and clinical course of AF.…”