Impact of Sodium-Glucose Cotransporter 2 Inhibitors on Postablation Atrial Fibrillation Recurrence: A Systematic Review and Meta-Analysis

Postablation atrial fibrillation (AF) recurrence remains an important clinical challenge. Recent evidence suggests sodium-glucose cotransporter 2 inhibitors (SGLT2i) may reduce AF recurrence, but comprehensive data are limited. Electronic databases were systematically searched to identify studies evaluating clinical outcomes in patients with AF undergoing catheter ablation who received SGLT2i compared with those not receiving SGLT2i therapy. The primary outcome of interest was AF recurrence. Secondary outcomes included all-cause mortality and rehospitalization. Pooled effect estimates were calculated using random-effects models. The meta-analysis included 14 studies comprising 20,996 patients. Mean patient age was 65.9 ± 8.1 years, and mean follow-up duration was 16.4 months. SGLT2i therapy was associated with a significantly reduced risk of postablation AF recurrence compared to control (risk ratios [RRs]: 0.65, 95% confidence intervals [CIs], 0.58-0.72, P < 0.0001). Secondary outcomes demonstrated reductions in all-cause mortality (RR: 0.67, 95% CI, 0.49-0.93, P = 0.01) and rehospitalizations (RR: 0.80, 95% CI, 0.72-0.88, P < 0.0001). Moderate heterogeneity was observed for the primary outcome (I2 = 47.6%), but subgroup analyses showed no significant interaction by study design (P = 0.83). SGLT2i therapy is associated with a substantial reduction in postablation AF recurrence and improved cardiovascular outcomes. However, the evidence is predominantly observational; large-scale randomized controlled trials are needed to confirm these benefits and refine clinical guidelines.