The role of periodontitis as a modifier of diabetes mellitus in older patients with atrial fibrillation.

BACKGROUND: Atrial fibrillation (AF) is a common arrhythmia driven by chronic inflammation, which promotes myocardial remodeling. While diabetes mellitus (DM) is known to exacerbate AF inflammation, the specific factors linking DM to AF pathology are complex and often confounded by conditions like periodontitis. This study aimed to determine the true contribution of DM and periodontitis to systemic inflammation in older AF patients, using the Ferritin/Hemoglobin ratio-a surrogate marker for chronic inflammation and impaired iron utilization.

METHODS: This single-center, retrospective observational study included older AF patients undergoing catheter ablation (CA), categorized into DM and Non-DM groups. We collected demographic data, cardiac parameters, metabolic indices (HbA1c, and periodontitis markers, including the number of Residual roots and periodontal pocket depth (PPD). Principal Component Analysis (PCA) and subsequent multiple regression were performed using the Ferritin/Hb ratio as the dependent variable to identify independent inflammatory predictors.

RESULTS: The DM group exhibited a higher inflammatory and metabolic risk profile, including significantly higher Body Mass Index, HbA1c, and C-reactive protein, as well as significantly poorer oral hygiene (higher Residual roots). Multiple regression analysis demonstrated that the number of teeth with PPD > 4 mm was the strongest independent positive predictor of the Ferritin/Hb ratio. Other positive predictors included Left atrium diameter. Notably, the presence of DM itself was not the most influential factor, and the mean PPD showed a paradoxical negative association, suggesting that local lesion severity (PPD > 4 mm count) is more critical than the extent of the disease.

CONCLUSION: The presence of severe periodontal lesions -rather than DM status alone-is independently and significantly associated with systemic inflammation and impaired iron utilization in older AF patients. This indicates that periodontitis acts as a major mediating factor in DM-related AF pathology. We recommend that proactive periodontal treatment and oral hygiene management be integrated alongside optimal glycemic control as crucial therapeutic strategies to suppress AF inflammation.

CLINICAL TRIAL NUMBER: Not applicable.