Autonomic dysfunction is associated with brief episodes of atrial fibrillation in type 2 diabetes
Abstract
Background and aims This study aimed to investigate the relationship between asymptomatic episodes of atrial fibrillation (AF) and abnormalities of the autonomic nervous system in type 2 diabetic patients who did not have evidence of atrial fibrillation at baseline. Methods and results In a multicentric cross-sectional controlled study, 1992 patients with type 2 diabetes were screened. All underwent ambulatory ECG recording for 48-hour at 3, 6, 9, and 12months. Heart rate variability (HRV) was used as indicator of autonomic activity. One hundred seventy-six diabetics with silent atrial fibrillation episodes (SAFE group) and 288 without silent atrial fibrillation (non-SAFE group) were enrolled. These selected diabetics were matched on clinical and anthropometric data to 120 control subjects without diabetes of the control group. HRV analysis evidenced that LF/HF ratio was significantly higher in the SAFE group than in the non-SAFE group (P Conclusions This study originally showed a strong relationship between autonomic dysfunction and silent atrial fibrillation in type 2 diabetes.
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Diabetes and AF frequently coexist because of associations with other risk factors.
“Diabetes and AF frequently coexist because of associations with other risk factors.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [279]
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“Autonomic dysfunction, another consequence of insulin resistance, can increase sympathetic tone and reduce heart rate variability, both of which have been associated with increased AF susceptibility (29, 30).”
Dysglycaemia and Autonomic Dysfunction: The Diabetes Prevention Program Outcomes Study
Echouffo-Tcheugui, J., Liu, X., Soliman, E., Pi-Sunyer, X., Golden, S. H., Dagogo-Jack, S., White, N. H., Budoff, M., Ibebuogu, U., Darwin, C., et al. (2026) · Diabetes, obesity and metabolism · doi:10.1111/dom.71111
Wang, Y., Zhu, L., Huang, X.-Y., Zhou, Z.-J., Xu, Y., Sun, B.-X., Li, J.-H., Yu, L.-M., & Wang, H.-S. (2026) · Cellular Signalling · doi:10.1016/j.cellsig.2026.112797
Damgaard, M., Kokla, M., Gerwig, R., Mizrak, H. I., Hecquet, S. K., Muk, T., Kaur, G., Brock, B., Hansen, C., & Størling, J. (2026) · Diabetes, obesity and metabolism · doi:10.1111/dom.71066
Vempati, R., Toquica-Gahona, C., Haddad, F., Manickavelan, H. V., Zakaria, F., Hanna, J., Sanusi, M., Bhatt, P., Haddad, R., Mohammed, F., et al. (2026) · Journal of Molecular Pathology · doi:10.3390/jmp7030025
“Diabetic autonomic neuropathy has been implicated in AF initiation and maintenance through altered vagal–sympathetic balance, increased P-wave dispersion, and transient adrenergic surges preceding AF episodes [139–141].”
Early autonomic neuropathy in prediabetes: an overlooked driver of cardiometabolic risk
Concepción-Zavaleta, M., Fuentes-Mendoza, J., Concepción-Urteaga, L., Castillo-Balderas, S. A., Siguas, J. C. M., Paz-Ibarra, J., & Quiroz-Aldave, J. (2026) · Expert Review of Cardiovascular Therapy · doi:10.1080/14779072.2026.2696292
“…associated with worsening autonomic dysfunction and a substantially critical cardiovascular prognosis, highlighting the clinical importance of identifying CAN during earlier stages of dysglycemia, since atherosclerotic CVD is still the leading cause of death and disability in these patients [7,8].”
Li, W., Guo, L., & Huang, H. (2026) · Medicine · doi:10.1097/md.0000000000048651
“[32] This process promotes AF persistence and progression, ultimately contributing to an increased risk of short-term mortality in critically ill patients.”
Zhang, X., Yin, Y.-P., Zhu, Q.-R., Jia, S., Ge, W.-L., & Xia, S. (2026) · Medicine · doi:10.1097/md.0000000000049012
“[34] In summary, the interaction among inflammation, nutrition, and immunity forms a complex vicious cycle that accelerates the progression of AF.”
Jagoda, C. (2026) · Annals of Noninvasive Electrocardiology · doi:10.1111/anec.70171
“Cardiac autonomic neuropathy in T2DM skews autonomic balance toward sympathetic dominance, heightening AF susceptibility and contributing to silent episodes (Kuehl and Stevens 2012; Rizzo et al. 2015).”
A Modified Beagle Model of Inducible Atrial Fibrillation Using a Right Atrium Pacemaker
Yang, S., Mei, B., Liu, H., Li, W., Wang, C.-Q., Yang, M., Yue, Y., & Wu, Z.-K. (2020) · Brazilian Journal of Cardiovascular Surgery · doi:10.21470/1678-9741-2019-0363
Comparison of Long-term Memory Function in Elderly Across Mind Activity and Diabetes Mellitus-type 2
Shabani, S., Shabani, S., Dehghani, M., & Habibi, M. (2016) · Journal of Behavior Therapy And Mental Health · doi:10.14302/issn.2474-9273.jbtm-16-1308
“This, in turn, leads to the elevated risk of heart attacks and cardiovascular diseases (4), stroke (5), advanced kidney diseases (6), retinopathy and blindness (7), ischemia (8) peripheral organs gangrene (9), peripheral neuropathy (10), autonomic nervous system dysfunctions (11), delirium (12), and microstructural ab…”
BackgroundResearch Progress on the Relationship between Type 2 Diabetes Mellitus and Atrial Fibrillation
Liu, B.-Y. (2025) · Advances in Clinical Medicine · doi:10.12677/acm.2025.15102981
Kanorskiy, S. (2018) · Kardiologiia · doi:10.18087/cardio.2469
“Весьма часто ФП и СД встречаются у больных одновременно [4, 5].”
Sato, H., Yamauchi, Y., Azegami, K., Miyamoto, T., Otomo, K., Hirao, K., Isobe, M., & Internationals, O. (2017) · doi:10.15436/2378-6914.17.1192
“We could not investigate the influence of antiarrhythmic drug on ECG and autonomic function[25].”
Background
- Authors
- Rizzo, M. R., Sasso, F. C., Marfella, R., Siniscalchi, M., Paolisso, P., Carbonara, O., Capoluongo, M. C., Lascar, N., Pace, C., Sardu, C., Passavanti, B., Barbieri, M., Mauro, C., & Paolisso, G.
- Affiliations
- University of Campania "Luigi Vanvitelli" (IT)
- Ospedale Antonio Cardarelli (IT)
- Corresponding author
- Marfella, Raffaele
- ORCID
- Venue
- Journal of Diabetes and its Complications
- Publisher
- Elsevier BV
- Published
- 2015-01
- Volume
- 29
- Issue
- 1
- Pages
- 88-92
- ISSN
- 0891-6632 (ISSN-L)
- 1056-8727
- OpenAlex
- W2086367530
- Cited by
- 100
- References
- 0
- Citations by year
- 2026: 10 · 2025: 4 · 2024: 9 · 2023: 5 · 2022: 12 · 2021: 8 · 2020: 8 · 2019: 11 · 2018: 10 · 2017: 2 · 2016: 18 · 2015: 3
- FWCI
- 5.29
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Diabetes and its Complications (publishedVersion)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli" (submittedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- atrial fibrillation, type 2 diabetes, autonomic dysfunction, heart rate variability, LF/HF ratio, silent atrial fibrillation, autonomic nervous system, atrial fibrillation burden, Holter monitoring
- MeSH terms
- Atrial Fibrillation, Autonomic Nervous System Diseases, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Humans, Male, Middle Aged, Retrospective Studies, Severity of Illness Index, Time Factors, Electrocardiography, Ambulatory, Comorbidity, Prevalence, Multivariate Analysis, Confidence Intervals, Logistic Models, Odds Ratio, Risk Assessment
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