Premium
Effect of metformin on outcomes of catheter ablation for atrial fibrillation
Author(s) -
Deshmukh Amrish,
Ghannam Michael,
Liang Jackson,
Saeed Mohammed,
Cunnane Ryan,
Ghanbari Hamid,
Latchamsetty Rakesh,
Crawford Thomas,
Batul Syeda A.,
Chung Eugene,
Bogun Frank,
Jongnarangsin Krit,
Pelosi Frank,
Chugh Aman,
Morady Fred,
Oral Elif,
Oral Hakan
Publication year - 2021
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.14954
Subject(s) - medicine , atrial fibrillation , metformin , cardiology , interquartile range , hazard ratio , catheter ablation , sinus rhythm , diabetes mellitus , coronary artery disease , ejection fraction , type 2 diabetes , proportional hazards model , heart failure , confidence interval , endocrinology , insulin
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.