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Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. May 15, 2023; 14(5): 512-527
Published online May 15, 2023. doi: 10.4239/wjd.v14.i5.512
Diabetes mellitus and atrial fibrillation-from pathophysiology to treatment
Marianna Leopoulou, Panagiotis Theofilis, Athanasios Kordalis, Nikolaos Papageorgiou, Marios Sagris, Evangelos Oikonomou, Dimitris Tousoulis
Marianna Leopoulou, Panagiotis Theofilis, Athanasios Kordalis, Nikolaos Papageorgiou, Marios Sagris, Dimitris Tousoulis, 1st Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 11527, Greece
Evangelos Oikonomou, 3rd Cardiology Clinic, ‘Sotiria’ Chest Diseases Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 11527, Greece
Author contributions: Tousoulis D contributed to the conceptualization; Leopoulou M and Theofilis P contributed to the investigation; Kordalis A, Papageorgiou N, Oikonomou E, Tousoulis D contributed to the supervision; Leopoulou M and Theofilis P wrote the original draft; Kordalis A, Papageorgiou N, Sagris M, Oikonomou E, and Tousoulis D edited the original draft; all authors have read and agree to the published version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dimitris Tousoulis, MD, PhD, Professor, 1st Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Vas. Sofias 114, Athens 11527, Greece. drtousoulis@hotmail.com
Received: January 20, 2023
Peer-review started: January 20, 2023
First decision: February 8, 2023
Revised: February 21, 2023
Accepted: April 7, 2023
Article in press: April 7, 2023
Published online: May 15, 2023
Processing time: 114 Days and 20.4 Hours
Abstract

Type 2 diabetes mellitus (T2DM) is a leading risk factor for cardiovascular complications around the globe and one of the most common medical conditions. Atrial fibrillation (AF) is the most common supraventricular arrhythmia, with a rapidly increasing prevalence. T2DM has been closely associated with the risk of AF development, identified as an independent risk factor. Regarding cardio-vascular complications, both AF and T2DM have been linked with high mortality. The underlying pathophysiology has not been fully determined yet; however, it is multifactorial, including structural, electrical, and autonomic pathways. Novel therapies include pharmaceutical agents in sodium-glucose cotransporter-2 inhibitors, as well as antiarrhythmic strategies, such as cardioversion and ablation. Of interest, glucose-lowering therapies may affect the prevalence of AF. This review presents the current evidence regarding the connection between the two entities, the pathophysiological pathways that link them, and the therapeutic options that exist.

Keywords: Atrial fibrillation; Diabetes mellitus; Pathophysiology; Treatment

Core Tip: Diabetes mellitus (DM) and atrial fibrillation (AF) are interconnected pathological conditions that are associated with excess morbidity and mortality. DM is implicated in AF’s pathophysiology, with mechanisms involving structural remodeling, electrical alterations, autonomic dysfunction, and dysglycemia. The management of this deleterious combination is multifaceted and includes the use of conventional methods such as direct oral anticoagulation, electrical cardioversion, and antiarrhythmic drugs. Sodium-glucose cotransporter-2 inhibitors, catheter ablation, and left atrial appendage occlusion represent appealing modern approaches, whose efficacy in this subgroup of patients needs to be thoroughly examined.