Diabetes mellitus and atrial fibrillation: Pathophysiological mechanisms and potential upstream therapies

- Diabetes represents a novel risk factor for atrial fibrillation.
- The underlying pathophysiology is complex.
- Autonomic, electrical, and structural remodeling play a critical role.
- Also, connexin remodeling and glycemic fluctuations promote atrial remodeling.
- Upstream therapies may have a role in this setting.

Diabetes mellitus (DM) represents one of the most important risk factors for atrial fibrillation (AF) while AF is a strong and independent marker of overall mortality and cardiovascular morbidity in diabetic patients. Autonomic, electrical, electromechanical, and structural remodeling, including oxidative stress, connexin remodeling and glycemic fluctuations seem to be implicated in AF pathophysiology in the setting of DM. The present review highlights the association between DM and AF, provides a comprehensive overview of the responsible pathophysiological mechanisms and briefly discusses potential upstream therapies for DM-related atrial remodeling.