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Impact of SGLT2 Inhibitors on AF Recurrence After Ablation
Quick Takes
- In a retrospective, propensity-matched analysis, use of SGLT2 inibitors in patients with atrial fibrillation (AF) and type 2 diabetes mellitus (T2DM) who had undergone AF catheter ablation was associated with lower odds for AF recurrence as measured by cardioversion, new antiarrhythmic use, and redo ablation.
- SGLT2 inhibitor use in patients with AF and T2DM undergoing AF ablation was associated with lower odds for all-cause mortality, all and heart failure hospitalization, but the risk for stroke was no different.
Study Questions:
What is the impact of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on atrial fibrillation (AF) recurrence in patients with type 2 diabetes mellitus (T2DM) who have undergone an AF ablation?
Methods:
The authors used data from a multicenter research network aggregating data from electronic medical records across 120 US health care organizations. This was a retrospective, propensity-matched analysis of adults with T2DM who had undergone AF ablation between 2014–2021. The primary outcome was composite of need for cardioversion, new antiarrhythmic (AAD) use, or redo AF ablation anytime 3 months after index AF ablation. Other outcomes included heart failure (HF) hospitalization, stroke, all-cause hospitalization, and mortality.
Results:
The study included 10,974 patients not on SGLT2i and 2,366 patients on SGLT2i, and patients receiving SGLT2i had a higher prevalence of cardiac risk factors. Propensity matching dropped the sample size to 2,225 patients in each cohort. A composite of cardioversion, new AAD use, or redo ablation was lower in patients receiving SGLT2i (odds ratio, 0.68; 95% confidence interval, 0.60-0.78). Odds for all-cause hospitalization, HF hospitalization, and all-cause mortality were lower with SGLT2i. However, no difference was noted with regard to stroke between the two groups.
Conclusions:
In a retrospective, propensity-matched analysis of administrative claims data set, use of SGLT2i in patients with T2DM who had undergone AF ablation was associated with a lower risk of recurrent AF, all-cause mortality, and hospitalization.
Perspective:
Benefits of SGLT2i have been established in HF and coronary artery disease. This study signals that benefits with SGLT2i may extend to patients with AF as well. While catheter ablation for AF is increasingly more common, AF recurs frequently. This study suggests that use of SGLT2i in AF patients with T2DM after an ablation was associated with a reduced risk for AF recurrence. However, risk for stroke was not modified by use of SGLT2i. Notably, over half of the patients included had a diagnosis of HF, and therefore, benefits noted may be due to the beneficial impact of SGLT2i in HF. The primary limitation of this study is its observational design. Accordingly, prospective studies are needed to confirm these findings.
Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Prevention, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure
Keywords: Ablation Techniques, Anti-Arrhythmia Agents, Arrhythmias, Cardiac, Atrial Fibrillation, Catheter Ablation, Diabetes Mellitus, Type 2, Electric Countershock, Heart Failure, Recurrence, Risk Factors, Secondary Prevention, Sodium-Glucose Transporter 2 Inhibitors, Stroke
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