Association of SGLT2 inhibitors with post-ablation atrial fibrillation recurrence in individuals with heart failure or type 2 diabetes mellitus: a systematic review and meta-analysis

Background The impact of sodium–glucose cotransporter-2 inhibitors (SGLT2i) on post-ablation atrial fibrillation (AF) recurrence is still unclear. Accordingly, we investigated whether exposure to SGLT2i reduces post-ablation AF recurrence among individuals with heart failure (HF) or type 2 diabetes mellitus (T2DM). Methods We carried out a structured search of PubMed, Embase, and the Cochrane Library from database launch through August 17, 2025. Pooled analyses were generated with RevMan 5.4 and Stata 18. Results 11 studies were included, comprising 2 randomized controlled trials (RCTs) and 9 retrospective cohort studies, with a total of 7,664 individuals. Among them, 3,390 received SGLT2i therapy, and 4,274 received non-SGLT2i therapy. Compared with the non-SGLT2i, SGLT2i was linked to decreased post-ablation AF recurrence (RR: 0.61, 95% CI: 0.52–0.71, p < 0.001). Subgroup analyses showed consistent reductions in recurrence risk in individuals with AF and T2DM (RR: 0.74, 95% CI: 0.68–0.80, p < 0.001) as well as those with AF and HF (RR: 0.61, 95% CI: 0.50–0.74, p < 0.001). Furthermore, SGLT2i corresponded to reduced all-cause mortality (RR: 0.66, 95% CI: 0.48–0.91, p = 0.010), fewer rehospitalization (RR: 0.79, 95% CI: 0.72–0.88, p < 0.001), and a lower incidence of thromboembolic events (RR: 0.56, 95% CI: 0.36–0.86, p = 0.009). Conclusions Use of SGLT2i was linked to reduced post-ablation AF recurrence, and this association was consistent in AF individuals with T2DM as well as those with HF. Additionally, SGLT2i therapy correlated with reduced risks of all-cause mortality, rehospitalization, and thromboembolic events. Systematic Review Registration identifier CRD420251125971.