医学
心房颤动
内科学
二甲双胍
心脏病学
四分位间距
危险系数
导管消融
窦性心律
糖尿病
冠状动脉疾病
射血分数
2型糖尿病
比例危险模型
心力衰竭
置信区间
内分泌学
胰岛素
作者
Amrish Deshmukh,Michael Ghannam,Jackson J. Liang,Mohammed Saeed,Ryan Cunnane,Hamid Ghanbari,Rakesh Latchamsetty,Thomas Crawford,Syeda Atiqa Batul,Eugene H. Chung,Frank Bogun,Krit Jongnarangsin,Frank Pelosi,Aman Chugh,Fred Morady,Elif A. Oral,Hakan Oral
摘要
Abstract Background Diabetes mellitus (DM) is a risk factor for atrial fibrillation (AF). The effect of antidiabetic medications on AF or the outcomes of catheter ablation (CA) has not been well described. We sought to determine whether metformin treatment is associated with a lower risk of atrial arrhythmias after CA in patients with DM and AF. Methods and Results A first CA was performed in 271 consecutive patients with DM and AF (age: 65 ± 9 years, women: 34%; and paroxysmal AF: 51%). At a median of 13 months after CA (interquartile range: 6–30), 100/182 patients (55%) treated with metformin remained in sinus rhythm without antiarrhythmic drug therapy, compared with 36/89 patients (40%) not receiving metformin ( p = .03). There was a significant association between metformin therapy and freedom from recurrent atrial arrhythmias after CA in multivariable Cox hazards models (hazard ratio [HR]: 0.66; ±95% confidence interval [CI]: 0.44–0.98; p = .04) that adjusted for age, sex, body mass index, AF type (paroxysmal vs. nonparoxysmal), antiarrhythmic medication, obstructive sleep apnea, chronic kidney disease, coronary artery disease, left ventricular ejection fraction, and left atrial diameter. A Cox model that also incorporated other antidiabetic agents and fasting blood glucose demonstrated a similar reduction in the risk of recurrent atrial arrhythmias with metformin treatment (HR: 0.63; ±95% CI: 0.42–0.96; p = .03). Conclusions In patients with DM, treatment with metformin appears to be independently associated with a significant reduction in the risk of recurrent atrial arrhythmias after CA for AF. Whether this effect is due to glycemic control or pleiotropic effects on electroanatomical mechanisms of AF remains to be determined.
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