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AI-Generated response:

What are the risks associated with cardiac ablation in patients with diabetes?

Answer generated on June 4, 2024

The AI-generated responses are for illustration purposes only and should not be used for medical purposes.

Patients with diabetes undergoing cardiac ablation face increased risks, including higher complication rates and longer hospital stays.[1]

  • Diabetic patients have a higher rate of in-hospital complications following atrial fibrillation catheter ablation compared to non-diabetic patients (10.7% vs. 8.2%).[1]

  • Diabetes is associated with a longer length of stay in the hospital post-ablation.[1]

  • Diabetic autonomic neuropathy can complicate the management of hemodynamic responses during procedures like ablation, increasing the risk of profound and refractory hypotension during anesthesia.[2]

  • Cardiac autonomic neuropathy in diabetic patients is linked with increased risks of silent myocardial infarction and sudden death, which could complicate post-ablation recovery.[2]

  • The presence of diabetes is noted as a factor that increases the likelihood of complications from cardiac ablation procedures.[3]

Additional info

It is important to consider that diabetic patients may have underlying cardiovascular complications such as cardiomyopathy and increased mortality after myocardial infarction, which could influence both the approach to and outcomes of cardiac ablation.[2] Additionally, the management of these patients during the perioperative period requires careful monitoring and adjustment of medications due to altered hemodynamic responses.[2] High-volume ablation centers may offer better outcomes due to more experienced handling of complex cases, including those involving diabetic patients.[3] Therefore, selecting an appropriate facility and preparing for potential complications are crucial steps in managing diabetic patients undergoing cardiac ablation.

References

Reference 1

1.

D'Souza S, Elshazly MB, Dargham SR, et al. Clinical Cardiology. 2021;44(8):1151-1160. doi:10.1002/clc.23667. Copyright License: CC BY

Publish date: August 0, 2021.

BACKGROUND: Obesity and diabetes are risk factors for atrial fibrillation (AF) incidence and recurrence after catheter ablation. However, their impact on post-ablation complications in real-world practice is unknown. OBJECTIVES: We examine annual trends in AF ablations and procedural outcomes in obese and diabetic patients in the US and whether obesity and diabetes are independently associated with adverse outcomes. METHODS: Using the Nationwide Inpatient Sample (2005-2013), we identified obese and diabetic patients admitted for AF ablation. Common complications were identified using ICD-9-CM codes. The primary outcome included the composite of any in-hospital complication or death. Annual trends of the primary outcome, length-of-stay (LOS) and total-inflation adjusted hospital charges were examined. Multivariate analyses studied the association of obesity and diabetes with outcomes. RESULTS: An estimated 106 462 AF ablations were performed in the US from 2005 to 2013. Annual trends revealed a gradual increase in ablations performed in obese and diabetic patients and in complication rates. The overall rate of the primary outcome in obese was 11.7% versus 8.2% in non-obese and 10.7% in diabetic versus 8.2% in non-diabetic patients (p < .001). CONCLUSIONS: Obesity was independently associated with increased complications (adjusted OR, 95% CI:1.39, 1.20-1.62), longer LOS (1.36, 1.23-1.49), and higher charges (1.16, 1.12-1.19). Diabetes was only associated with longer LOS (1.27, 1.16-1.38).

Reference 2

2.

Elsevier ClinicalKey Clinical Overview

Complications and Prognosis Autonomic neuropathy is a complication of diabetes; further complications are sometimes difficult to attribute solely to the neuropathy, but there are some characteristic associations for which the presence of autonomic neuropathy appears to be an independent risk factor Cardiovascular complications Labile blood pressure Normal diurnal variation in blood pressure may be disrupted in cardiac autonomic neuropathy, resulting in the absence of a normal dip in nocturnal blood pressure Associated with left ventricular hypertrophy Some patients experience blood pressure elevations in the supine position at any time of day (supine hypertension) Management of supine hypertension and orthostatic hypotension can be challenging; scheduled use of short-acting antihypertensives (eg, captopril) at night coupled with daytime use of short-acting sympathomimetics or vasopressors may be reasonable Lack of normal hemodynamic response increases risk of profound and refractory hypotension during anesthesia Cardiomyopathy Systolic and diastolic dysfunction have been associated with cardiac autonomic neuropathy even in the absence of atherosclerotic coronary disease Silent myocardial infarction Absence of pain with myocardial ischemia may be multifactorial but is associated with the presence of cardiac autonomic neuropathy May delay recognition and treatment, contributing to worse prognosis of myocardial infarction for patients with diabetes Increased mortality after myocardial infarction Decreased heart rate variability is a marker of mortality risk Sudden death Cardiac autonomic neuropathy is associated with prolonged QTc interval and malignant arrhythmias Stroke Presence of cardiac autonomic neuropathy has been correlated with increased risk of ischemic stroke Gastrointestinal complications Bezoars may form as a result of poor gastrointestinal motility Gastritis and/or gastric ulcers may result from gastroparesis

Reference 3

3.

Elsevier ClinicalKey Clinical Overview

Follow-up Occur at a rate of less than 3%, with risk less than 1:1000 for a fatal complication More likely in older patients (older than 80 years) and in patients with diabetes, obesity, chronic obstructive pulmonary disease, peripheral vascular disease, renal failure, congestive heart failure, and coagulopathy Less likely to occur in high-volume ablation centers

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