The effects of SGLT2 inhibitors on atrial fibrillation recurrence and cardiac function after catheter ablation in patients with atrial fibrillation and heart failure: a retrospective cohort study and meta-analysis

Objective The impact of Sodium-glucose cotransporter 2 inhibitors (SGLT2i) on postoperative atrial fibrillation (AF) recurrence and cardiac function in patients with AF and heart failure (HF) undergoing catheter ablation remains unclear. Methods and results This study comprised two parts. Part 1 was a retrospective cohort study involving 168 patients with AF and HF who underwent first-time catheter ablation (SGLT2i group: n = 83; non-SGLT2i group: n = 85). Atrial arrhythmia recurrence rate was significantly lower in the SGLT2i group compared to the non-SGLT2i group (13.25% vs. 25.88%, P = 0.039). Multivariate Cox proportional hazards regression analysis identified severe atrial fibrosis (HR 2.80, 95% CI: 1.13–6.96, P = 0.026) and SGLT2i use (HR 0.45, 95% CI: 0.22–0.94, P = 0.033) as independent predictors of atrial arrhythmia recurrence. At 12-month follow-up, SGLT2i group had a smaller left atrial diameter (LA: 37.37 ± 4.25 mm vs. 39.25 ± 6.22 mm, P = 0.024) and a higher left ventricular ejection fraction (LVEF: 62.06 ± 11.39% vs. 58.89 ± 7.98%, P = 0.039). Part 2 was a meta-analysis. We systematically searched and included 13 studies-2 RCTs and 11 retrospective cohort studie, involving 7,954 patients (SGLT2i: 3518; non-SGLT2i: 4436). Results indicated that SGLT2i significantly reduced the risk of atrial arrhythmia recurrence after catheter ablation (RR = 0.59, 95% CI: 0.51–0.69, P < 0.001). Furthermore, SGLT2i was associated with reduced risks of all-cause mortality (RR: 0.66, 95% CI: 0.48–0.91, P = 0.011). Conclusion In patients with AF and HF, SGLT2i use is associated with a lower risk of AF recurrence after catheter ablation and with improvements in cardiac structure and function. SGLT2i is also associated with lower risks of all-cause mortality, rehospitalization, and HF events.