Work

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

Year: 2025

Type: article

Abstract: 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).

Source: JACC Asia

DOI: 10.1016/j.jacasi.2025.10.021