Potential triggers of atrial fibrillation in type 2 diabetes mellitus

Author(s): Bakhodir Narziev, Zulfiya Mirzarakhimova, Akmal Yakubov, Oybek Salaev, Ramesh Hamraev, Aliyor Ganiev, Sardorkhon Sultankhonov, Umida Yakubova

Introduction: Atrial fibrillation is an irregular heartbeat that accelerates to form blood clots in the chambers of the heart and leads to stroke, heart failure, and other cardiovascular complications. Diabetes mellitus itself has been identified as a risk factor for atrial fibrillation, but the association between them is unclear.

Materials and methods: We analyzed 70 patients with type 2 insulin non-dependent diabetes mellitus. All patients were examined in parallel Continuous Glucose (CGM) and ECG for 14 days. The study population divided into documented atrial fibrillation (AF group, n=16) and without atrial fibrillation (non-AF group, n=54) groups. We assessed the relationship between hypoglycemia, fasting plasma insulin, insulin resistance using the Homeostatic Model Assessment (HOMA-IR) equation, and the incidence of atrial fibrillation.

Results: We found a total of 46 episodes of documented Atrial Fibrillation (AF be defined as an arrhythmia lasting ≥ 30 seconds) lasted on the whole 596.9 minute, which was the most significant by the number (2.87 ± 2.05 per patient, p<0.0001) or the time (31.31 ± 16.57 min per patient, p<0.0001). We also found a maximum of 642.6 ± 567.2 single Premature Atrial Complexes (PACs) per patient in the AF group, compared to 84.6 ± 87.9, p=0.002. Despite this, there were significant differences by the following parameters: Couplet PACs (p=0.0015) and triplet or >3 PACs (p=0.0007). Over 14 days, a total of 263 hypoglycemic episodes or 5135 min hypoglycemic time were detected, the average number and time of hypoglycemic episodes were 8.0 ± 4.94 per person and 137.0 ± 63.17 min in AF group, and 2.5 ± 4.64 per person (p=0.0001), 54.5 ± 67.3 min (p=0.004) in the non-AF group. There was a statistically significant (p<0.0001) association between Fasting Plasma Insulin (FPI) and incident AF, more exactly, the mean level of FPI was 31 ± 6.1 mlU/L in the AF group, whereas was 11.3 ± 4.07 in the non-AF group. When we measured the HOMA-IR index, we found significant differences between AF and non-AF groups (11.2 ± 3.88 mmol/l vs. 4.3 ± 1.66 mmol/l, p<0.0001).

Conclusion: The parallel recording of continuous glucose and ECG are necessary to evaluate hypoglycemia-related atrial fibrillation in type 2 diabetes mellitus. Elevated fasting plasma insulin, as well as insulin resistance, are important predictors of atrial fibrillation development, but it needs further studies.