Sodium Glucose Cotransporter 2 Inhibitors Improve Long-term Atrial Fibrillation-free Survival After Catheter Ablation

Although sodium-glucose cotransporter 2 inhibitors (SGLT2i) are known to reduce the incidence of atrial fibrillation (AF) and AF-related adverse events, evidence on their prognostic effect in patients undergoing catheter ablation (CA) for AF is limited. In a single center, 614 patients (mean age 58.1 ± 9.9 years, 42.2% female) who underwent CA for AF were retrospectively divided into 2 groups according to SGLT2i treatment after the index procedure and followed up for 24 months. The primary outcome of the study was AF recurrence after the first 90-day blanking period after CA. Two separate Cox regression models were constructed to determine the predictors of AF recurrence. Rates of the primary outcome were 19.4% and 35.7% in the SGLT2i and non-SGLT2i groups, respectively. According to the multivariable model 1, which was established among the clinically relevant variables that were found to be statistically significant in univariable analysis, left atrial diameter (adjusted HR: 1.087, 95% CI, 1.054-1.122, P < 0.001), SGLT2i therapy (adjusted HR: 0.436, 95% CI, 0.286-0.665, P < 0.001), and nonparoxysmal AF (adjusted HR: 1.549, 95% CI, 1.039-2.309, P = 0.032) were independent predictors of recurrence after ablation. In model 2, SGLT2i treatment remained an independent predictor of AF recurrence along with significant variables such as age, heart failure with reduced ejection fraction, and previous stroke (adjusted HR: 0.315, 95% CI, 0.214-0.461, P < 0.001). The favorable efficacy of SGLT2i on the primary outcome was maintained in subgroup analyses. SGLT2i treatment is associated with lower recurrence after CA for AF in subgroups with and without diabetes or heart failure with reduced ejection fraction and in the overall patient population, independent of AF phenotype.