What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Atrial fibrillation with heart failure or type 2 diabetes mellitus undergoing catheter ablation (n=7664). Intervention: SGLT2 inhibitors vs. Non-SGLT2i therapy. Primary outcome: Post-ablation atrial fibrillation recurrence (RR 0.61, 95% CI 0.52-0.71, p=<0.001).

What does this research mean for the field?

SGLT2 inhibitors significantly reduce post-ablation atrial fibrillation recurrence, all-cause mortality, rehospitalization, and thromboembolic events compared to non-SGLT2i therapy in individuals with heart failure or type 2 diabetes mellitus. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

November 21, 2025Open Access

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

Q: What are the key findings of this study?

SGLT2 inhibitors significantly reduced post-ablation atrial fibrillation recurrence (RR 0.61) compared to non-SGLT2i therapy in individuals with heart failure or type 2 diabetes mellitus.

Q: What does this research mean for the field?

SGLT2 inhibitors significantly reduce post-ablation atrial fibrillation recurrence, all-cause mortality, rehospitalization, and thromboembolic events compared to non-SGLT2i therapy in individuals with heart failure or type 2 diabetes mellitus. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

JLJiaqi LiShenyang University of Technology FZFan ZhangTianjin University SFShaobo FanTianjin University

Key Result

SGLT2 inhibitors significantly reduced post-ablation atrial fibrillation recurrence (RR 0.61) compared to non-SGLT2i therapy in individuals with heart failure or type 2 diabetes mellitus.

Study Design

Type

Meta-Analysis (n=7,664)

Multicenter

Yes

Structured PICO

Does SGLT2i therapy reduce post-ablation AF recurrence in individuals with heart failure or type 2 diabetes mellitus?

Population

7,664 individuals with atrial fibrillation (AF) and either heart failure (HF) or type 2 diabetes mellitus (T2DM) who underwent catheter ablation, pooled from 11 studies (2 RCTs and 9 retrospective cohorts).

Intervention

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) therapy

Comparator

Non-SGLT2i therapy

Outcome

Post-ablation atrial fibrillation (AF) recurrencehard clinical

SGLT2 inhibitors are associated with a significantly reduced risk of atrial fibrillation recurrence, all-cause mortality, rehospitalization, and thromboembolic events following catheter ablation in patients with AF and concurrent HF or T2DM.

Main Result

Effect estimate: RR 0.61 (95% CI 0.52-0.71)

p-value: p=<0.001

Limitations

Included only two RCTs, whereas the remainder consisted of retrospective cohorts, rendering them susceptible to selection bias.
Only one study specifically enrolled AF individuals with HF but without T2DM; the other studies included varying proportions of individuals with T2DM or HF.
Ablation strategies varied across studies.
Most included studies used radiofrequency and cryoballoon as energy sources to varying degrees without specifying numbers, preventing subgroup analysis by energy type.
Could not assess the efficacy of different types of SGLT2i on post-ablation AF recurrence or evaluate potential differences across different HF subtypes.

Abstract

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.

Ask AI

Helpful

Bookmark

View Full Paper