Key result
SGLT2 inhibitors post-ablation cut late AF recurrence ~51% vs control at 3 to 12 months.
Why the study?
AF recurrence after catheter ablation remains a major clinical challenge, and SGLT2 inhibitors may attenuate atrial remodeling and fibrosis to improve post-ablation outcomes.
Do SGLT2 inhibitors reduce atrial fibrillation recurrence in patients undergoing catheter ablation for atrial fibrillation?
Meta-Analysis (n=452)
Do SGLT2 inhibitors reduce atrial fibrillation recurrence in patients undergoing catheter ablation for atrial fibrillation?
In patients undergoing catheter ablation for atrial fibrillation, SGLT2 inhibitor therapy is associated with a significant reduction in late AF recurrence (between 3 and 12 months) and lower NT-proBNP levels.
Answers are grounded in this paper and cite their sources.
SGLT2 inhibitors may reduce late AF recurrence and NT-proBNP after ablation; extends limited RCT evidence but requires larger trials before practice change.
Background: Atrial fibrillation (AF) recurrence after catheter ablation remains a major clinical challenge. Sodium-glucose cotransporter-2 (SGLT2) inhibitors may attenuate atrial remodeling and fibrosis, potentially improving post-ablation outcomes. We performed a systematic review and meta-analysis evaluating the efficacy of SGLT2 inhibitors after AF ablation. Methods: We searched PubMed, Cochrane Library, Scopus, and Web of Science for randomized controlled trials (RCTs) comparing SGLT2 inhibitors versus control therapy in patients undergoing AF catheter ablation. Random-effects meta-analysis pooled dichotomous outcomes as risk ratios (RRs) and continuous outcomes as standardized mean differences (SMDs). Reconstructed individual patient data from Kaplan-Meier curves were analyzed using pooled Cox regression, time-varying hazard models, landmark analysis, and restricted mean survival time (RMST). Results: Four RCTs (n = 452 patients) were included. Reconstructed patient-level analysis from 370 patients showed no significant overall reduction in AF recurrence (HR 0.73, 95% CI 0.48-1.11; P=0.14). However, landmark analysis after 30 days demonstrated significantly lower recurrence with SGLT2 inhibitors (HR 0.58, 95% CI 0.34-0.98; P=0.041). SGLT2 inhibitors significantly reduced late AF recurrence between 3 and 12 months compared with control therapy (13.2% vs. 26.0%; RR 0.49, 95% CI 0.29-0.82; P=0.006). No significant reduction was observed in early AF recurrence at 3 months (RR 0.50, 95% CI 0.10-2.53; P=0.40) or all-cause mortality. SGLT2 inhibitors significantly lowered NT-proBNP levels (SMD –0.59, 95% CI –0.88 to –0.29; P<0.001), with no significant differences in left atrial diameter, or AFEQT score. Conclusions: SGLT2 inhibitors after AF ablation were associated with lower late AF recurrence and reduced NT-proBNP levels, with benefits appearing beyond the early post-ablation period. Larger randomized trials are needed to confirm these findings.
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Awashra et al. (2026) conducted a meta-analysis in Atrial fibrillation undergoing catheter ablation (n=452). SGLT2 inhibitors vs. Control therapy was evaluated on Late atrial fibrillation recurrence between 3 and 12 months (RR 0.49, 95% CI 0.29-0.82, p=0.006). SGLT2 inhibitors after AF ablation reduced late AF recurrence at 3-12 months compared with control.
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