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Denise Guckel, Khuraman Isgandarova, Leonard Bergau, Misagh Piran, Mustapha El Hamriti, Guram Imnadze, Martin Braun, Moneeb Khalaph, Thomas Fink, Vanessa Sciacca, Georg Nölker, Young-Hee Lee, Diethelm Tschöpe, Philipp Sommer, Christian Sohns

• Diabetes mellitus (DM) plays a crucial role in the regulation of atrial fibrillation (AF). This study aimed to evaluate the outcome of pulmonary vein isolation (PVI) using a single-shot device in patients with AF and DM. A total of 531 consecutive patients undergoing initial cryoballoon (CB)-guided PVI were evaluated. Two hundred eighty-one patients (53%) suffered from paroxysmal AF (PAF; mean age 51 \(\pm\) 23.2 years, 26% female), 250 patients (48%) from persistent AF (PERS; 64 \(\pm\) 10.0 years old, 30% female) and 80 patients (15%) were diagnosed with coincidental DM (68 \(\pm\) 19.6 years old, 30% female). Follow-up visits were performed at 3, 6 and 12 months including 7-day Holter ECGs. Primary endpoint was the first documented recurrence of atrial tachyarrhythmia. AF recurrence occurred in 26% (140 patients). PAF patients with DM presented with a significantly higher risk for arrhythmia recurrence (Kaplan Meier analysis; Log rank \(\it p\) < 0.001 *). Multivariate analyses found DM to be an independent predictor (IP) for AF recurrence (\(\it p\) = 0.009 *, hazard ratio (HR) 4.363, confidence interval (CI) 1.456–13.074). In PERS, DM was associated with a 43% increase in AF recurrence (\(\it p\) = 0.320, HR 1.427, CI 0.707–2.879). DM has relevant effects on AF recurrence after PVI-only ablation approaches for AF. Major differences were observed in PAF as DM seems to favor the development of individual arrhythmia substrate, which is usually not yet present in PAF. In PERS, DM effects are less pronounced as individual fibrosis has already developed. Thus, personalized paths addressing individual arrhythmia substrates are needed in this specific cohort of patients.