{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T05:14:11Z","timestamp":1791004451713,"version":"4.1.0"},"reference-count":154,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2023,4,14]],"date-time":"2023-04-14T00:00:00Z","timestamp":1681430400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"SPACE2-CV-COVID-CM grant from REACT-EU","award":["PI18\/01016"],"award-info":[{"award-number":["PI18\/01016"]}]},{"name":"SPACE2-CV-COVID-CM grant from REACT-EU","award":["PI20\/00923"],"award-info":[{"award-number":["PI20\/00923"]}]},{"name":"Comunidad de Madrid and European Regional Development Fund","award":["PI18\/01016"],"award-info":[{"award-number":["PI18\/01016"]}]},{"name":"Comunidad de Madrid and European Regional Development Fund","award":["PI20\/00923"],"award-info":[{"award-number":["PI20\/00923"]}]},{"name":"Fondo de Investigaci\u00f3n Sanitaria-IS","award":["PI18\/01016"],"award-info":[{"award-number":["PI18\/01016"]}]},{"name":"Fondo de Investigaci\u00f3n Sanitaria-IS","award":["PI20\/00923"],"award-info":[{"award-number":["PI20\/00923"]}]},{"name":"Carlos III","award":["PI18\/01016"],"award-info":[{"award-number":["PI18\/01016"]}]},{"name":"Carlos III","award":["PI20\/00923"],"award-info":[{"award-number":["PI20\/00923"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Atrial fibrillation (AF) is the most common arrhythmia in adults and diabetes mellitus (DM) is a major risk factor for cardiovascular diseases. However, the relationship between both pathologies has not been fully documented and new evidence supports the existence of direct and independent links. In the myocardium, a combination of structural, electrical, and autonomic remodeling may lead to AF. Importantly, patients with AF and DM showed more dramatic alterations than those with AF or DM alone, particularly in mitochondrial respiration and atrial remodeling, which alters conductivity, thrombogenesis, and contractile function. In AF and DM, elevations of cytosolic Ca2\u207a and accumulation of extra cellular matrix (ECM) proteins at the interstitium can promote delayed afterdepolarizations. The DM-associated low-grade inflammation and deposition\/infiltration of epicardial adipose tissue (EAT) enforce abnormalities in Ca2+ handling and in excitation-contraction coupling, leading to atrial myopathy. This atrial enlargement and the reduction in passive emptying volume and fraction can be key for AF maintenance and re-entry. Moreover, the stored EAT can prolong action of potential durations and progression from paroxysmal to persistent AF. In this way, DM may increase the risk of thrombogenesis as a consequence of increased glycation and oxidation of fibrinogen and plasminogen, impairing plasmin conversion and resistance to fibrinolysis. Additionally, the DM-associated autonomic remodeling may also initiate AF and its re-entry. Finally, further evidence of DM influence on AF development and maintenance are based on the anti-arrhythmogenic effects of certain anti-diabetic drugs like SGLT2 inhibitors. Therefore, AF and DM may share molecular alterations related to Ca2+ mobility, mitochondrial function and ECM composition that induce atrial remodeling and defects in autonomic stimulation and conductivity. Likely, some specific therapies could work against the associated cardiac damage to AF and\/or DM.<\/jats:p>","DOI":"10.3390\/jcm12082868","type":"journal-article","created":{"date-parts":[[2023,4,14]],"date-time":"2023-04-14T02:03:38Z","timestamp":1681437818000},"page":"2868","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Atrial Fibrillation and Diabetes Mellitus: Dangerous Liaisons or Innocent Bystanders?"],"prefix":"10.3390","volume":"12","author":[{"given":"Ana","family":"Lorenzo-Almor\u00f3s","sequence":"first","affiliation":[{"name":"Internal Medicine Department, Hospital General Universitario Gregorio Mara\u00f1\u00f3n, 28007 Madrid, Spain"},{"name":"Department of Medicine, School of Medicine, Universidad Complutense de Madrid, 28007 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jes\u00fas","family":"Casado Cerrada","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Hospital Universitario de Getafe, 28095 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1781-5364","authenticated-orcid":false,"given":"Luis-Antonio","family":"\u00c1lvarez-Sala Walther","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Hospital General Universitario Gregorio Mara\u00f1\u00f3n, 28007 Madrid, Spain"},{"name":"Department of Medicine, School of Medicine, Universidad Complutense de Madrid, 28007 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0830-8897","authenticated-orcid":false,"given":"Manuel","family":"M\u00e9ndez Bail\u00f3n","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Hospital Universitario Clinico San Carlos, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5515-6078","authenticated-orcid":false,"given":"\u00d3scar","family":"Lorenzo Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Laboratory of Diabetes and Vascular Pathology, Instituto de Investigaciones Sanitarias-Fundaci\u00f3n Jim\u00e9nez D\u00edaz, Universidad Aut\u00f3noma, 28040 Madrid, Spain"},{"name":"Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM) Network, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,4,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","article-title":"2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC","volume":"1","author":"Hindricks","year":"2021","journal-title":"Eur. 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