Rotary activity as the main electrophysiology mechanism of the persistent form of atrial fibrillation of patients with type 2 diabetes mellitus

BACKGROUND: treatment of patients with the persistent form of atrial fibrillation (AF) is an unsolved problem of the healthcare system due to a high risk of disability and mortality. Considering a low effectiveness of drug treatment for AF, intervention treatment (catheter ablation) is the main technology for eliminating trigger activity of pulmonary veins. The frequency of AF recurrence of patients with diabetes mellitus (DM) after surgery is higher than of patients without disorders of carbohydrate metabolism what could be explained with non-pulmonary vein triggers on the posterior wall of the left atrial (LA). Opportunities of preoperative diagnostic of non-pulmonary vein triggers of AF and personalization of catheter ablation reports of patients with DM has not been determined yet.

AIM: to estimate an opportunity of preoperative diagnostic of rotor activities for personalization of catheter ablation reports of patients with the persistent form of AF and DM.

MATERIALS AND METHODS: the study included 25 patients with persistent form of AF. Group 1: patients with DM aged 58–77. Group 2: patients without DM aged 38–76. To determine treatment tactics, all patients were made noninvasive electrophysiological mapping with the construction of a personalized virtual cardiac phantom. All patients were undergone interventional treatment.

RESULTS: taking into account the identified localizations of rotor activity, the interventional treatment protocol was optimized: radiofrequency catheter isolation of PV was supplemented with focal (32%), linear (20%), and combined (focal+linear; 4%) radiofrequency effects.

Extrapulmonary rotor activity was more common in patients with DM than in patients without diabetes.

CONCLUSION: non-invasive electrophysiological mapping of the heart with the construction of a virtual heart phantom allows to verify rotor activity in the LA.

In patients with diabetes type 2 and persistent AF rotor activity is more common than in patients without carbohydrate metabolism disorders (p<0.001). Personalization of the catheter ablation protocol in the left atrium based on rotor activity marked during pre-surgery examination helps to improve long-term results of maintaining sinus rhythm.ividual microRNAs involved in myocardial remodeling processes in young patients with type 1 diabetes mellitus.

1. Van Gelder IC, Rienstra M, Bunting KV, et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2024;45(36):3314-3414. doi: https://doi.org/10.1093/eurheartj/ehae176

2. Kolbin AS, Mosikyan AA, Tatarsky BA. Socioeconomic burden of atrial fibrillations in Russia: seven-year trends (2010-2017). Journal of Arrhythmology. 2018;(92):42–48. (In Russ.)

3. Golukhova EZ, Milievskaya EB, Filatov AG, et al. Aritmologiya – 2022. Narusheniya ritma serdtsa i provodimosti. Moscow: Natsional’nyi nauchno–prakticheskii tsentr serdechno–sosudistoi khirurgii im. AN Bakuleva; 2023. (In Russ).

4. Zotov AS, Khamnagadaev IA, Sakharov ER, et al. The First Experience of the Hybrid Approach in Surgical Treatment of Atrial Fibrillation. Journal of Clinical Practice. 2022;13(4):38–50. (In Russ.) doi: https://doi.org/10.17816/clinpract116052

5. Haïssaguerre M, Jaïs P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998;339(10):659-666. doi: https://doi.org/10.1056/NEJM199809033391003

6. Ushanova FO., Izmaylova MY, Nadybina MN. Cardiac arrhythmias in patients with type 2 diabetes mellitus. ш. 2024;5(2):12–19. (In Russ.) doi: https://doi.org/10.62751/2713-0177-2024-5-2-12

7. Sapel’nikov OV, Cherkashin DI, Grishin IR, et al. Ablatsiya rotornykh ochagov po dannym neinvazivnogo kartirovaniya u patsientov s persistiruyushchei i dlitel’no-persistiruyushchei fibrillyatsiei predserdii: sredne-otdalennye rezul’taty. Meditsinskii al’manakh. 2017;48(3):89–92. (In Russ.)

8. Patent RUS №2837527/ 27.12.2024. Khamnagadaev IA, Belousov LA, Zubarev SV, et al. Method for determining indications for interventional treatment of patients with non-paroxysmal forms of atrial fibrillation taking into account clinical, functional and electrophysiological data. (In Russ.)

9. Gherasim L. Association of Atrial Fibrillation with Diabetes Mellitus, High Risk Comorbidities. Maedica (Bucur). 2022;17(1):143-152. doi: https://doi.org/10.26574/maedica.2022.17.1.143

10. Khamnagadaev IA, Zotov AS, Shelest OO, et al. Surgical approaches to maintaining sinus rhythm in patients with type 2 diabetes and long-term persistent atrial brillation. Diabetes mellitus. 2024;27(6):572–579. (In Russ.) doi: https://doi.org/10.14341/DM13242

11. Zotov AS, Khamnagadaev IA, Sakharov ER, et al. The first experience of using a hybrid approach in the surgical treatment of atrial fibrillation. J Clin Pract. 2022;13(4):38–50. (In Russ.) doi: https://doi.org/10.17816/clinpract116052

12. Jalife J, Berenfeld O, Mansour M. Mother rotors and fibrillatory conduction: a mechanism of atrial fibrillation. Cardiovasc Res. 2002;54(2):204-216. doi: https://doi.org/10.1016/S0008-6363(02)00223-7

13. Arakelyan MG, Bockeria LA, Vasilieva EY, et al. 2020 Clinical guidelines for Atrial fibrillation and atrial flutter. Russian Journal of Cardiology. 2021;26(7):4594. (In Russ.) doi: https://doi.org/10.15829/1560-4071-2021-4594

14. Packer DL, Mark DB, Robb RA, et al. Effect of Catheter Ablation vs Antiarrhythmic Drug Therapy on Mortality, Stroke, Bleeding, and Cardiac Arrest Among Patients With Atrial Fibrillation: The CABANA Randomized Clinical Trial. JAMA. 2019;321(13):1261-1274. doi: https://doi.org/10.1001/jama.2019.0693

15. Maesen B, Verheule S, Zeemering S, et al. Endomysial fibrosis, rather than overall connective tissue content, is the main determinant of conduction disturbances in human atrial fibrillation. Europace. 2022;24(6):1015-1024. doi: https://doi.org/10.1093/europace/euac026

16. Vengrzhinovskaya OI, Bondarenko IZ, Shatskaia OA, et al. Imaging techniques for diffuse myocardial fibrosis as a marker of high cardiovascular risk in young patients with type 1 diabetes mellitus. Terapevticheskii Arkhiv. 2024;96(12):1161–1167. (In Russ.) doi: https://doi.org/10.26442/00403660.2024.12.203000

17. Gottlieb LA, Dekker LRC, Coronel R. The Blinding Period Following Ablation Therapy for Atrial Fibrillation. JACC Clin Electrophysiol. 2021;7(3):416-430. doi: https://doi.org/10.1016/j.jacep.2021.01.011

18. Anselmino M, Matta M, D’ascenzo F, et al. Catheter ablation of atrial fibrillation in patients with diabetes mellitus: a systematic review and meta-analysis. Europace. 2015;17(10):1518-1525. doi: https://doi.org/10.1093/europace/euv214

19. Dedukh EV, Yashkov MV, Taymasova IA, et al. Algorithm for determining the fibrosis stage using high-density mapping. Journal of Arrhythmology. 2022;29(3):29-36. (In Russ.) doi: https://doi.org/10.35336/VA-2022-3-04