Outcomes of SGLT2 Inhibitor Use in Atrial Fibrillation Patients and Effects on Left Atrial Function Assessed by Speckle‑Tracking Echocardiography: A Systematic Review

Background: Atrial fibrillation (AF) is the most common sustained arrhythmia and is strongly associated with type 2 diabetes mellitus (T2DM), heart failure (HF), and adverse cardiovascular outcomes. Sodium–glucose cotransporter-2 inhibitors (SGLT2i) are established therapies for T2DM and HF, with emerging evidence suggesting benefits in atrial remodeling and arrhythmia prevention.Objective: This systematic review aimed to evaluate the clinical and imaging evidence linking SGLT2i therapy with atrial arrhythmia incidence, recurrence, and left atrial (LA) function assessed by speckle-tracking echocardiography (STE).Methods: Following PRISMA 2020 guidelines, we systematically searched PubMed, Embase, Scopus, and Web of Science for randomized controlled trials (RCTs), meta-analyses, cohort, and imaging studies involving adults with AF or atrial flutter (AFL). Eligible outcomes included AF/AFL incidence, recurrence post-ablation, and LA strain measures. Studies without original data, case reports, and animal studies were excluded. Two reviewers independently screened studies and extracted data. Quality was appraised using study design–specific tools. Due to heterogeneity, results were synthesized narratively.Results: Eighteen studies were included. Meta-analyses pooling >88,000 participants demonstrated consistent AF/AFL risk reduction with SGLT2i. Observational studies indicated lower AF recurrence after ablation. Imaging cohorts consistently reported LA strain improvements, suggesting favorable atrial remodeling. Limitations included passive AF ascertainment in RCTs, heterogeneous imaging protocols, and modest sample sizes in imaging studies.Conclusion: SGLT2i therapy is associated with reduced AF incidence and recurrence, alongside improvements in LA function. While findings support potential atrial protective effects, dedicated RCTs with prespecified arrhythmia endpoints are needed to confirm these benefits and inform clinical practice.