Surgical ablation for atrial fibrillation: impact of diabetes mellitus

Abstract

Abstract Background: Diabetes mellitus (DM) is an independent risk factor for atrial fibrillation (AF). Surgical ablation or "maze procedure" is an option for patients with (AF) undergoing concomitant or isolated cardiac surgery. The aim of this study was to evaluate the impact of DM on early and long-term outcomes of patients following surgical AF ablation. Methods: We performed an observational cohort study in Israel’s largest tertiary care center. All data of patients who underwent surgical AF ablation, between 2006 and 2021 were extracted from our departmental database. Patients were divided into Group I (non-diabetic patients) and Group II (diabetic patients). We compared the two groups with respect to freedom from recurrent atrial arrhythmia, and mortality rate. Results: The study population included 606 patients. Group I (non-DM patients), consisting of 484 patients, and Group II (DM type 2 patients), comprised 122 patients. Patients with DM were older, had more hypertension and incidence of cerebrovascular accident (CVA)/transient ischemic attack (TIA), higher EuroSCORE (p <.05 for all), and a longer bypass time - 130±40 vs. 122±36 min (p=0.028). The mean follow-up duration was 39.0 ± 22.7 months. Freedom from atrial fibrillation was similar between the non-DM and DM groups after a 1-year follow-up, 414 (88.2%) vs. 101 (87.1%) (p = 0.511), after a 3-year follow-up, 360 (86.3%) vs. 84 (79.9%) (p = 0.290) and after a 5-year follow-up, 226 (74.1%) vs. 55 (71.5%) (p = 0.622) respectively. Furthermore, 1- and 3-year mortality was similar between non-DM and DM groups, 2.5% vs. 4.9%, (p = 0.226) and 5.6% vs. 10.5% (p = 0.076) respectively. 5-year mortality was higher in Group II (DM patients) compared with Group I (non-DM patients), 11.1% vs. 23.4% (p = 0.009). Conclusion: Surgical ablation had a high success rate, with freedom from recurrent atrial arrhythmia at 1- 3- and 5- years follow-up in both the DM and non-DM groups. Furthermore,1- and 3-year mortality after surgical ablation was also similar in both groups. However, 5-year mortality was higher in the DM group.