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Updated: Jan 10, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Effects of Sodium Glucose Co-Transporter 2 Inhibitors on Atrial Fibrillation Recurrences After Catheter Ablation in
Saketh Parsi1, Kunal Sonavane2, Usha Ravi3
1Department of Internal Medicine, Ascension Seton Medical Center Austin, Austin, TX 78705, USA.
Insights
Sodium glucose co-transporter 2 inhibitors (SGLT2i) reduce atrial fibrillation (AF) recurrence after catheter ablation (CA). This meta-analysis found SGLT2i significantly decreased AF recurrence up to 24 months post-procedure.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Sodium glucose co-transporter 2 inhibitors (SGLT2is) are known to reduce heart failure hospitalizations.
- SGLT2is have also shown potential in decreasing atrial fibrillation (AF) recurrence, even post-catheter ablation (CA).
- Proposed mechanisms include RAAS suppression, reduced oxidative stress, improved myocardial efficiency, and attenuated cardiac remodeling.
Purpose of the Study:
- To evaluate the efficacy of SGLT2 inhibitors in reducing AF recurrence in patients who have undergone catheter ablation.
- To analyze secondary outcomes including AF recurrence at various follow-up intervals and the impact on left atrial diameter.
Main Methods:
- A systematic review and meta-analysis of randomized controlled trials (RCTs) and retrospective studies.
- Included studies compared SGLT2i use versus non-SGLT2i use in patients post-CA for AF.
- Primary outcome: AF recurrence at final follow-up. Secondary outcomes: AF recurrence at specific intervals (6-42 months), multivariate risk, and effect on left atrial diameter.
Main Results:
- Nine studies (N=6874) were analyzed; 3181 received SGLT2i and 3693 did not.
- SGLT2i significantly decreased AF recurrence by final follow-up (OR=0.62, p=0.008).
- Significant reductions in AF recurrence were observed at 12-24 months post-ablation (OR=0.58, p=0.0001), but an increased risk was noted at 36-42 months (OR=1.41, p=0.004).
Conclusions:
- SGLT2 inhibitors demonstrate a significant reduction in AF recurrence following catheter ablation.
- The beneficial effect appears most pronounced between 12 to 18 months post-ablation.
- Further investigation into long-term effects beyond 24 months is warranted.
Abstract:
Background/Objectives: Sodium glucose co-transporter 2 inhibitors (SGLT2is) have demonstrated a reduction in heart failure (HF) hospitalizations in HF patients and decreased recurrence of atrial fibrillation (AF), including in those who have undergone catheter ablation (CA). The effects of SGLT2i are likely due to suppression of the renin-angiotensin-aldosterone system, reduction in oxidative stress with subsequent improvement in myocardial efficiency, and attenuation of cardiac remodeling. We aim to present the effects of SGLT2i on AF recurrence in patients who have undergone CA for AF. Methods: This is a systematic review and meta-analysis of randomized controlled trials (RCTs) and retrospective studies evaluating the effect of SGLT2i on AF recurrence following CA compared with non-SGLT2i. The primary outcome was the recurrence of AF by the final follow-up reported in each study. Secondary outcomes include AF recurrence by the first follow-up within 12 to 24 months and follow-up intervals (6, 12, 18, 24, and 36 to 42 months) post-ablation, multivariate risk of AF recurrence, and the effect on left atrial diameter (LAD) (less than 45 mm vs. greater than or equal to 45 mm). For risk of bias (ROB) analysis, the NIH ROB and Cochrane ROB2 tool were used. All statistical, heterogeneity, and sensitivity analyses were conducted using Cochrane Review Manager. A random-effect model was employed for all pooled statistical analyses. Results: A total of nine studies, two RCTs and seven retrospective studies, were included (N = 6874) for the primary outcome. Compared to non-SGLT2i (N = 3693), SGLT2i (N = 3181) significantly decreased AF recurrence by the final follow-up (OR = 0.62; 95% CI: 0.45-0.85; p = 0.008). For secondary outcomes, SGLT2i significantly reduced AF recurrence by the first follow-up within 12 to 24 months post-ablation (OR = 0.58; p = 0.0001) and by the different follow-up periods, 6-month (OR = 0.53; p = 0.02), 12-month (OR = 0.56; p = 0.0001), 18-month (OR = 0.55; p = 0.01), and 24-month (OR = 0.60; p = 0.12) follow-up periods. On the other hand, by 36 to 42 months, SGLT2i was associated with increased risk of AF recurrence (OR = 1.41; p = 0.004). Conclusions: We conclude that SGLT2i demonstrated a reduction in AF recurrence following CA, particularly by 12 to 18 months post-ablation.
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