Sodium-glucose cotransporter 2 inhibitors are more effective than dipeptidyl peptidase 4 inhibitors in preventing mid-term recurrence after atrial fibrillation ablation

Abstract Purpose We investigated whether Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are more effective in suppressing mid-term atrial fibrillation (AF) recurrences after catheter ablation (CA) compared to dipeptidyl peptidase-4 inhibitors (DPP4i). Methods This study is an additional analysis of a prospective randomized controlled open-label clinical study aimed at comparing the suppressive effects of SGLT2i with DPP4i on AF recurrence after CA. Eighty patients with AF and type-2 DM were randomly assigned to the Tofogliflozin (SGLT2i) or Anagliptin (DPP4i) group with a computer-generated random sequence. After 1 year, the medication could be changed at the attending physician's discretion. Results 70 patients (70.3±8.1 years, 48 male, 30 with paroxysmal AF, 38 with SGLT2i) were analyzed. The proportion of patients who continued to receive the same type of medication at follow-up periods beyond one year was 33% in the DPP4i group and 52% in the SGLT2i group. Recurrent AF was detected in 32 out of 70 patients (46%) during the follow-up period (30.3±26.3 months), and the AF recurrence ratio was higher in DPP4i group than in SGLT2i group (Figure). Conclusion SGLT2i might suppress mid-term AF recurrence after CA more than DPP4i due to its effect on the early-term after ablation.