Atrial fibrillation risk in patients suffering from type I diabetes mellitus. A review of clinical and experimental evidence

Atrial fibrillation (AF) and diabetes mellitus (DM) are commonly encountered in clinical practice. Although, the long term macrovascular and microvascular sequela of DM are well validated, the association between the less prevalent type 1 DM (T1DM) and atrial arrhyth-mogenesis is poorly understood. In the present review we highlight the current experimen-tal and clinical data addressing this complex interaction. Animal studies support that T1DM, characterized by insulin deficiency and glycemic variability, impairs phosphatidyli-nositol 3 kinase (PI3K)/protein kinase B signaling pathway. This pathway holds a central role in atrial electrical and structural remodeling responsible for arrhythmia initiation and maintenance. The molecular ??footprint?of T1DM in atrial myocytes seems to involve a state of increased oxidative stress, impaired glucose transportation, ionic channel dysreg-ulation and eventually fibrosis. On the contrary only a few clinical studies have examined the role of T1DM as an independent risk factor for AF development, and are discussed here. Further research is needed to solidify the real magnitude of this association and to inves-tigate the clinical implications of PI3K molecular signaling pathway in atrial fibrillation management. ? 2021 Elsevier B.V. All rights reserved.

Automated summary

Research suggests that the association between type 1 diabetes and atrial arrhythmogenesis is complex, with insulin deficiency and glycemic variability impairing the phosphatidylinositol 3 kinase (PI3K)/protein kinase B signaling pathway, leading to atrial electrical and structural remodeling. Further studies are needed to better understand this relationship and its clinical implications.