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SGLT2 Inhibitors and Outcomes After Ablation for Atrial Fibrillation
Quick Takes
- In a study of 80 patients with type 2 diabetes mellitus undergoing ablation of AF, the use of tofogliflozin, a SGLT2 inhibitor, was associated with a lower recurrence rate than with the use of anagliptin (DPP-4 inhibitor).
- Tofogliflozin, an SGLT2 inhibitor, may be useful as an adjunct treatment option to catheter ablation for AF.
Study Questions:
What are the effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on atrial fibrillation (AF) after catheter ablation?
Methods:
This was a prospective, randomized controlled study comparing the suppressive effect of SGLT2i versus dipeptidyl peptidase-4 (DPP-4) inhibitors on AF recurrence after catheter ablation. Eighty AF patients with type 2 diabetes mellitus were randomized to the tofogliflozin group (20 mg/d) or the anagliptin group (200 mg/d) stratified according to left atrial diameter and AF type (paroxysmal or nonparoxysmal AF) at screening. The primary outcome was AF recurrence at 12 months after CA.
Results:
There were a total of 70 randomized patients. Recurrent AF was detected in 24 (34%), and the AF recurrence ratio was higher in the anagliptin group than in the tofogliflozin group (47% vs. 24%; p = 0.0417). Univariate analysis revealed that compared with the nonrecurrence group (n = 46), the recurrence group (n = 24) had a higher prevalence rate of nonparoxysmal AF, elevated B-type natriuretic peptide, higher urinary albumin-creatinine ratio, lower rate of SGLT2i use, larger left atrial diameter, elevated E wave, lower left ventricular ejection fraction, and lower rate of cryoballoon pulmonary vein isolation.
Conclusions:
The authors concluded that compared with anagliptin, tofogliflozin achieved greater suppression of AF recurrence after catheter ablation in patients with type 2 diabetes mellitus.
Perspective:
SGLT2i have been shown to reduce heart failure, hospitalization, and cardiovascular death in patients with diabetes mellitus. In addition to increasing the urinary elimination of glucose, SGLT2i have multiple pleiotropic effects of glucose-independent and direct cardiac protection that may improve atrial remodeling. Some studies suggested that SGLT2i may reduce atrial tachyarrhythmia. Moreover, treatment of the risk factors of AF, such as diabetes mellitus, obesity, and hypertension, is important from the perspective of managing AF recurrence after ablation. In this study, the authors compared outcomes of ablation of AF in patients with type 2 diabetes mellitus randomized to tofogliflozin (SGLT2i) versus anagliptin (DPP-4 inhibitor). The results showed that tofogliflozin use was associated with a significantly lower risk of recurrent AF after ablation compared with anagliptin in univariate analysis. The study was small and further randomized trials are needed to fully evaluate the role of SGLT2i on AF in patients with diabetes.
Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Heart Failure and Cardiac Biomarkers, Hypertension
Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Atrial Remodeling, Catheter Ablation, Creatinine, Diabetes Mellitus, Type 2, Dipeptidyl-Peptidase IV Inhibitors, Heart Failure, Hypertension, Natriuretic Peptide, Brain, Obesity, Primary Prevention, Pulmonary Veins, Risk Factors, Sodium-Glucose Transporter 2 Inhibitors, Stroke Volume, Tachycardia, Ventricular Function, Left
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