Diabetes and ALDH2 Gene Polymorphism on Post-Ablation Atrial Fibrillation Recurrence.

BACKGROUND

Type 2 diabetes mellitus (T2DM) and mitochondrial aldehyde dehydrogenase 2 (ALDH2) gene polymorphism exhibit significant associations with atrial fibrillation (AF) prevalence.

OBJECTIVES

This study aimed to evaluate the combined risk of T2DM and ALDH2 gene polymorphism in AF recurrence after radiofrequency catheter ablation.

METHODS

This prospective multicenter cohort study enrolled 324 patients undergoing their first successful ablation from 3 centers. Patients were stratified by T2DM status and ALDH2 genotype. The primary outcome was AF recurrence, defined as atrial arrhythmia lasting ≥30 seconds after a 3-month blanking period post-ablation, analyzed using Kaplan-Meier survival curves and multivariable Cox proportional hazards regression.

RESULTS

At a median follow-up of 12.00 months (Q1-Q3: 10.98-12.00 months), 86 patients experienced AF recurrence. The risk of recurrence was significantly higher in patients with T2DM (44.3%, n = 39 of 88; 95% CI: 32.9%-53.8%) than in those without (19.9%, n = 47 of 236; 95% CI: 14.7%-24.9%; P < 0.001). T2DM and ALDH2-variant patients experienced the highest cumulative incidence of AF recurrence after ablation (n = 24 of 43, 55.8%; 95% CI: 38.2%-68.4%; P < 0.001). Multivariable regression analysis showed that the combination of T2DM and ALDH2-variant were the most powerful independent predictor for AF recurrence at 1-year (adjusted HR: 4.20; 95% CI: 2.04-8.64; P < 0.001).

CONCLUSIONS

T2DM and ALDH2-variant significantly increases AF recurrence after radiofrequency catheter ablation. The link between genetic predisposition and diabetic metabolism highlights the potential for combined risk stratification to identify high-risk T2DM with AF patients for targeted preventive strategies of recurrence after ablation (AAAF [Association Between ALDH2 Gene Polymorphism and Atrial Fibrillation]; NCT05524142).