SGLT2 inhibitor reduces atrial tachyarrhythmia recurrence post-cryoballoon ablation: a prospective observational cohort study in patients with and without diabetes

The impact of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on atrial tachyarrhythmia (ATa) recurrence in patients undergoing cryoballoon ablation is not well understood. To evaluate the impact of SGLT2i on Ata recurrence in atrial fibrillation (AF) patients with and without diabetes, we conducted a prospective observational cohort study at a tertiary care hospital in China. A total of 582 adult patients who underwent cryoballoon ablation were included. Of these, 209 patients received SGLT2i treatment prospectively (intervention group), while 373 patients received standard care (control group). The primary endpoint was ATa recurrence during the longest follow-up period. We utilized multivariate Cox proportional hazards regression models to assess the risk of ATa recurrence. The mean age was 61.2 ± 9.9 years and 61.2% were men. 13.1% of patients had type 2 diabetes and 66.5% had paroxysmal AF. The AF duration was 26.3 ± 36.6 months. Over a median follow-up of 13 months, ATa recurrence was observed in 40 patients (19.1%) receiving SGLT2i and in 131 patients (35.1%) in the control group. After multivariate adjustment, SGLT2i use remained independently associated with a lower risk of ATa recurrence (hazard ratio [HR], 0.34 [95% CI, 0.20–0.59], P < 0.001). SGLT2i use consistently demonstrated a significant association with a reduced risk of ATa recurrence, in patients with and without diabetes, and in patients with paroxysmal and persistent AF. SGLT2i was associated with a decreased risk of ATa recurrence following an initial AF cryoballoon ablation, irrespective of their diabetes status and AF type. This study was prospectively registered at the Chinese Clinical Trial Registry (ChiCTR2200058691) on April 14, 2022, prior to participant enrollment.