Efficacy of sodium-glucose cotransporter 2 inhibitors on preventing atrial arrhythmia recurrences after atrial fibrillation ablation in patients with heart failure

Abstract

Background: Atrial fibrillation (AF) is frequently observed in patients with heart failure (HF), and the efficacy of catheter ablation for AF treatment has been established; however, recurrence of atrial arrhythmia is possible. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been reported to suppress AF recurrence in patients with diabetes; however, the efficacy of SGLT2i after AF ablation in patients with HF has not been fully elucidated.

Methods: A total of 141 consecutive patients with HF aged ≤75 years who underwent AF ablation were analyzed. Patients with follow-up shorter than six months were excluded. The primary endpoint was atrial arrhythmia recurrence after a 3-month blanking period. The type of recurrence, incidence of hospitalization for HF, and mortality rates were also evaluated.

Results: Forty-five patients used SGLT2i, and the median follow-up period was 372 days. The incidence of atrial arrhythmia recurrence was significantly lower in patients taking SGLT2i than in those that were not taking SGLT2i (20.0 % vs. 38.5 %, p = 0.029; log-rank test, p = 0.034). In the multivariate analysis, intake of SGLT2i was associated with a low risk of atrial arrhythmia recurrence (hazard ratio: 0.38, 95 % confidence interval: 0.18-0.80, p = 0.010). The rate of AF recurrence was significantly lower than the rate of atrial tachycardia/flutter recurrence in the SGLT2i group (44.4 % vs. 83.8 %; p = 0.013). The incidence of hospitalization for HF and/or death was low in both groups (0 % in the SGLT2i group and 1.0 % in the non-SGLT2i group). In 24 propensity score-matched pairs, the SGLT2i group had a lower recurrence rate (16.7 % vs. 45.8 %, p = 0.029, log-rank test, p = 0.047) than the non-SGLT2i group.

Conclusions: SGLT2i use in patients with HF was associated with a lower atrial arrhythmia recurrence after AF ablation; hence, SGLT2i administration for patients with HF who will undergo AF ablation may be beneficial.