Type 1 diabetes mellitus and atrial fibrillation: clinical relationships, mechanistic insights, and therapeutic implications

Type 2 diabetes mellitus (T2D) is an established risk factor for multiple cardiovascular diseases including atrial fibrillation (AF). The causal relationship between type 1 diabetes mellitus (T1D) and AF is poorly defined. T1D and AF share many underlying risk factors, but how T1D may promote AF independently of obesity and other features typical of T2D is not known. Here, we critically review the quality of the available clinical evidence specifically linking AF with the distinct characteristics of T1D and evaluate the mechanistic insights from preclinical models. We provide a conceptual overview of candidate contributing players and highlight important gaps in knowledge, unmet clinical needs, and potential therapeutic perspectives.