Key result
SGLT2 inhibitors reduce AF recurrence ~38% after catheter ablation versus non-SGLT2 inhibitors.
Why the study?
SGLT2 inhibitors reduce heart failure hospitalizations and AF recurrence, but their effects on AF recurrence following catheter ablation required synthesis.
Does SGLT2i reduce the recurrence of atrial fibrillation in patients who have undergone catheter ablation for AF?
Meta-Analysis (n=6,874)
Does SGLT2i reduce the recurrence of atrial fibrillation in patients who have undergone catheter ablation for AF?
Effect estimate: OR 0.62 (95% CI 0.45-0.85)
p-value: p=0.008
SGLT2 inhibitors are associated with a significant reduction in atrial fibrillation recurrence following catheter ablation, particularly at 12 to 18 months post-ablation.
Supports adjunctive SGLT2i use after AF ablation to cut recurrence; extends their benefits to post-ablation rhythm control.
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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Parsi et al. (2025) conducted a meta-analysis in Atrial fibrillation (n=6,874). Sodium glucose co-transporter 2 inhibitors (SGLT2i) vs. non-SGLT2i was evaluated on Recurrence of AF by the final follow-up (OR 0.62, 95% CI 0.45-0.85, p=0.008). SGLT2 inhibitors significantly decreased atrial fibrillation recurrence following catheter ablation compared to non-SGLT2 inhibitors (OR 0.62; 95% CI 0.45-0.85; p=0.008).
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