Of hits, players, and goalkeepers: the case of arrhythmias in diabetes

The propensity to arrhythmias in diabetic patients has been recognized since a long time. The occurrence of atrial and ventricular arrhythmias is increased in diabetic patients often because of poor but also despite optimal glycaemic control.1 The 2019 European Society of Cardiology (ESC) guidelines for diabetes2 identify the abnormal substrate as a major culprit for sustained ventricular arrhythmias (‘The risk of cardiac events is usually dictated by underlying heart disease rather than ectopic beats’) and recommend a thorough examination of cardiac function and coronary perfusion by imaging techniques, similar to that pursued in non-diabetes mellitus (DM) cardiopathic patients. However, it is concluded, ‘obvious trigger factors’ must be also investigated.