Diabetes mellitus and atrial fibrillation-from pathophysiology to treatment

Table 1 Pathophysiologic mechanisms connecting type 2 diabetes mellitus and Atrial Fibrillation

	Involved mechanism	Result
Structural remodelling	Inflammation	Atrial fibrosis and dilatation
	Oxidative stress
	Expression of profibrotic growth factors
	Enhanced collagen synthesis and high fibroblast activity
	Activation of the (RAAS) system
	Obesity and adiposity
Electrical remodelling	Longer activation times	Conduction abnormalities
	Abnormal current densities and refractory periods
	Electromechanical delay
	Affected gap junction function
Autonomic dysfunction	Downsizing of parasympathetic nervous system	Autonomic imbalance
	Upregulation of sympathetic stimuli
Glycemic parameters	Sympathetic activation due to hypoglycaemia	AF susceptibility
	Remodelling due to chronic hyperglycemia
	Oxidative stress and fibrosis due to glycemic fluctuations
	Fibrosis due to adipokines

AF: Atrial fibrillation.