Diabetes and Atrial Fibrillation: Insight From Basic to Translational Science Into the Mechanisms and Management

Bharat K Kantharia; Mohammadreza Tabary; Lingling Wu; Xinyu Wang; Bharat Narasimhan; Dominik Linz; Jordi Heijman; Xander H T Wehrens

doi:10.1111/jce.16655

Diabetes and Atrial Fibrillation: Insight From Basic to Translational Science Into the Mechanisms and Management

J Cardiovasc Electrophysiol. 2025 Oct;36(10):2755-2766. doi: 10.1111/jce.16655. Epub 2025 Apr 1.

Authors

Bharat K Kantharia^{1

2}, Mohammadreza Tabary³, Lingling Wu⁴, Xinyu Wang³, Bharat Narasimhan⁵, Dominik Linz⁶, Jordi Heijman⁷, Xander H T Wehrens³

Affiliations

¹ Cardiovascular and Heart Rhythm Consultants, New York, New York, USA.
² Icahn School of Medicine at Mount Sinai, New York, New York, USA.
³ Departments of Integrative Physiology and Medicine, Cardiovascular Research Institute, Baylor College of Medicine, Houston, Texas, USA.
⁴ East Carolina University Brody School of Medicine, Greenville, North Carolina, USA.
⁵ Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁶ Maastricht University Medical Center, Maastricht, The Netherlands.
⁷ Division of Medical Physics and Biophysics, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria.

PMID: 40170342
DOI: 10.1111/jce.16655

Abstract

In spite of significant progress made in the management in recent decades, atrial fibrillation (AF) continues to cause increased mortality and significant morbidities, including heart failure and stroke. Diabetes mellitus (DM) is an independent risk factor for AF, and adds risks to increased mortality and hospitalizations when present along with AF. The pathophysiology of AF related to DM is complex with many inter-related factors. Atrial cardiomyopathy (atriopathy) related to structural changes from subcellular abnormalities and fibrosis, coupled with cardiac mechanical dysfunction, abnormal ion expression, dysregulation of the renin-angiotensin-aldosterone system and the autonomic nervous system function, play crucial roles in genesis and progression of AF. In this review, we discuss insights from basic to translational science into the mechanisms and management related to AF associated with DM.

Keywords: antidiabetic drugs; atrial cardiomyopathy; atrial fibrillation; atriopathy; diabetes mellitus; fibrosis; inflammation.

Publication types

Review

MeSH terms

Action Potentials
Animals
Anti-Arrhythmia Agents* / adverse effects
Anti-Arrhythmia Agents* / therapeutic use
Atrial Fibrillation* / diagnosis
Atrial Fibrillation* / epidemiology
Atrial Fibrillation* / metabolism
Atrial Fibrillation* / physiopathology
Atrial Fibrillation* / therapy
Diabetes Mellitus* / diagnosis
Diabetes Mellitus* / drug therapy
Diabetes Mellitus* / epidemiology
Diabetes Mellitus* / mortality
Diabetes Mellitus* / physiopathology
Diabetes Mellitus* / therapy
Heart Rate* / drug effects
Humans
Hypoglycemic Agents / adverse effects
Hypoglycemic Agents / therapeutic use
Renin-Angiotensin System
Risk Factors
Translational Research, Biomedical*
Translational Science, Biomedical*

Substances

Anti-Arrhythmia Agents
Hypoglycemic Agents

Grants and funding

This study was supported by grants received from the Novo Nordisk Foundation (NNF Young Investigator Awards 2021, project NNF21OC0066480), the Netherlands Organization for Scientific Research (NWO/ZonMW Vidi 09150171910029), the Dutch Heart Foundation (Grant number 01-002-2022-0118, EmbRACE consortium), and the National Institutes of Health (R01HL089598, R01HL147108, R01HL153350, and R01HL160992).