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

Jianya Huang,1,* Yiqiu Gu,1,* Ye Deng,1,* Yujing Miao,1 Li Deng,1 Jingyi Wang,1 Yang Zhang,2 Jun Wei,2 Ling Sun,3 Yuan Ji,1 Qingjie Wang1 1Department of Cardiology, The Third Affiliated Hospital of Nanjing Medical University, Changzhou, Jiangsu, People’s Republic of China; 2Department of Cardiovascular Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China; 3Department of Cardiology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, Jiangsu, People’s Republic of China*These authors contributed equally to this workCorrespondence: Qingjie Wang, Department of Cardiology, The Third Affiliated Hospital of Nanjing Medical University, 68# Gehu Road, Changzhou, Jiangsu, 213000, People’s Republic of China, Email [email protected] Yuan Ji, Department of Cardiology, The Third Affiliated Hospital of Nanjing Medical University, 68# Gehu Road, Changzhou, Jiangsu, 213000, People’s Republic of China, Email [email protected]: 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