A Prospective Cohort Study on the Impact of SGLT2 Inhibitors on the 12‑Month Recurrence Risk of Atrial Fibrillation After Catheter Ablation

Background: Catheter ablation (CA) effectively maintains sinus rhythm in atrial fibrillation (AF) patients, but its postoperative recurrence rate remains high (20– 40%), necessitating safe and effective adjuvant therapies. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have cardioprotective effects, yet high-quality evidence on their value and impact on AF recurrence post-CA is insufficient. Methods: This single-center observational study prospectively enrolled AF patients undergoing first-time cardiac radiofrequency CA (Jan 2020-Dec 2023). Patients were split into the SGLT2i group (106 cases, 10mg daily dapagliflozin/empagliflozin) and the control group (324 cases). 1:3 propensity score matching (PSM, 13 variables including gender, age, BMI) balanced baselines. Kaplan-Meier analysis compared 12-month AF-free survival; univariate and multivariate Cox models analyzed SGLT2i-AF recurrence association. Results: A total of 430 patients were enrolled, with an overall 12-month AF recurrence rate of 21.63% (93/430). Kaplan-Meier analysis demonstrated higher 12-month AF-free survival in the SGLT2i group (total cohort Log-rank P = 0.019; PSM cohort Log-rank P = 0.016). Multivariate Cox analysis confirmed SGLT2i use was independently associated with a reduced risk of AF recurrence (total cohort: HR = 0.459, 95% CI = 0.228– 0.926, P = 0.030; PSM cohort: HR = 0.458, 95% CI = 0.223– 0.939, P = 0.033). Conclusion: Postoperative SGLT2i use correlates with lower 12-month AF recurrence risk in first-time CA patients, suggesting SGLT2i as a potential adjuvant therapy. Given the observational nature of this study, these findings should be considered hypothesis-generating. Large-scale multicenter randomized controlled trials are needed for verification. Keywords: atrial fibrillation, SGLT2 inhibitors, radiofrequency catheter ablation, recurrence, propensity score matching analysis