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Meta-Analysis
. 2024 Sep;24(5):629-640.
doi: 10.1007/s40256-024-00661-5. Epub 2024 Jul 4.

Impact of SGLT2 Inhibitors on Atrial Fibrillation Recurrence after Catheter Ablation in Type 2 Diabetes Mellitus: A Meta-Analysis of Reconstructed Kaplan-Meier Curves with Trial Sequential Analysis

Youssef Soliman  1 , Mohamed Abuelazm  2 , Basma Ehab Amer  3   4 , Mishaal Hukamdad  5 , Mohamed Hatem Ellabban  3   6 , Nada Ibrahim Hendi  3   7 , Adel Mouffokes  3   8 , Basel AbdelAzeem  9 , Hatem Hassaballa  10
Affiliations
Meta-Analysis

Impact of SGLT2 Inhibitors on Atrial Fibrillation Recurrence after Catheter Ablation in Type 2 Diabetes Mellitus: A Meta-Analysis of Reconstructed Kaplan-Meier Curves with Trial Sequential Analysis

Youssef Soliman et al. Am J Cardiovasc Drugs. 2024 Sep.

Abstract

Purpose: The role of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in managing cardiovascular outcomes in patients with type 2 diabetes mellitus (T2DM) is evolving. This meta-analysis seeks to explore the influence of SGLT2i on the recurrence of atrial fibrillation (AF) following catheter ablation (CA) in individuals with T2DM qualitatively and quantitatively.

Methods: A comprehensive literature search was conducted in electronic databases. Studies meeting predefined criteria were included. Individual patient data (IPD) were used from reconstructed time-to-event data to estimate hazard ratios (HRs) and 95% confidence intervals for AF recurrence. IPD meta-analysis was followed by a direct meta-analysis to assess the risk of AF recurrence.

Results: A total of five studies [one randomized controlled trial (RCT) and four cohort studies] were included in this study, and five studies were included in the qualitative analysis, while four studies comprising 1043 patients with T2DM were included in the quantitative analysis. The pooled Kaplan-Meier curve based on reconstructed data showed a significantly lower risk of AF recurrence in the SGLT2i group compared with all antidiabetic drugs (log-rank P = 0.00011) and dipeptidyl-peptidase IV inhibitors (DPP4i) (log-rank P = 0.01). Cox regression analysis showed consistent results. Direct meta-analysis showed that SGLT2i, compared with all antidiabetic medications (HR 0.57, 95% CI [0.44, 0.73], I2) and DPP4i (HR 0.41, 95% CI [0.24, 0.70], I2), was associated with a lower risk of AF recurrence.

Conclusions: SGLT2i are associated with a reduced risk of AF recurrence after CA in patients with T2DM. These results suggest that SGLT2i is promising in improving clinical outcomes for this population.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
PRISMA flow chart of the screening process
Fig. 2
Fig. 2
KM curve of reconstructed individual patient data a pooled from the included four studies; b stratified by study
Fig. 3
Fig. 3
Bar chart comparing the pooled recurrence rates and stratification by study
Fig. 4
Fig. 4
KM curve of reconstructed individual patient data from the two studies (SGLT2i versus DPP4i)
Fig. 5
Fig. 5
Direct meta-analysis using the random-effects model and hazard ratios reported in the included studies
See this image and copyright information in PMC

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