For patients with diabetes and atrial fibrillation (AF), higher hemoglobin (Hb) A1c levels in the year prior to ablation are associated with an increased risk for post-ablation AF recurrence, according to results published in JACC: Clinical Electrophysiology.
The study included participants with diabetes undergoing AF ablation at the Cleveland Clinic between January 1, 2013, and December 31, 2016 (n=298). The researchers collected recurrence data during a mean follow-up of 25.92 ± 20.26 months post-ablation. The researchers used univariable and multivariable Cox proportional hazards models to determine independent predictors of AF recurrence.
The results indicated that participants with higher HbA1c levels at the time of ablation had an increased risk for post-ablation recurrence. Among participants with HbA1c >9% at the time of ablation, recurrent AF developed in 68.75% compared with 32.4% of those with HbA1c <7% (P <.0001).
After multivariable analysis, the researchers found that only the 12-month trend in HbA1c had a significant association with AF recurrence. Among participants with a worsening trend in HbA1c during the 12 months prior to ablation, recurrent AF developed in 91.1% compared with 2% of participants with a ≥10% improvement in HbA1c (P <.0001).
The researchers also found that older age was associated with higher AF recurrence rates, with a hazard ratio of 1.056 (95% CI, 1.012-1.057; P =.002).
During the 12-month period prior to ablation, there were no major changes in body mass index or systolic blood pressure among participants.
“Every effort should be made to optimize glycemic control before proceeding with AF ablation,” the researchers wrote.
Donnellan E, Aagaard P, Kanj M, et al. Association between pre-ablation glycemic control and outcomes among diabetic patients undergoing atrial fibrillation ablation [published online July 31, 2019]. JACC Clin Electrophysiol. doi:10.1016/j.jacep.2019.05.018