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Efficacy of SGLT2 inhibitors on outcomes after catheter ablation for atrial fibrillation

Sodium-glucose cotransporter 2 inhibitors ( SGLT2i ) have recently been a significant focus of attention because of their multiple pleiotropic effects. However, the impact of SGLT2i on atrial fibrillation remains unclear.

The goal of a study was to examine the effects of SGLT2i on atrial fibrillation after catheter ablation.

The prospective, randomized controlled study compared the suppressive effect of SGLT2 inhibitors versus dipeptidyl peptidase-4 inhibitors on atrial fibrillation recurrence after catheter ablation.
Eighty atrial fibrillation patients with type 2 diabetes mellitus were randomized ( by a computer-generated random sequence ) to the Tofogliflozin group ( 20 mg/d ) or the Anagliptin group ( 200 mg/d ) stratified according to left atrial diameter and atrial fibrillation type ( paroxysmal atrial fibrillation [ PAF ] or non-paroxysmal atrial fibrillation [ NPAF ] ) at screening.

The primary outcome was atrial fibrillation recurrence at 12 months after catheter ablation.

Seventy patients were analyzed ( mean age 70.3 ± 8.1 years; 48 male; 30 with paroxysmal atrial fibrillation; 38 Tofogliflozin treated ).

Recurrent atrial fibrillation was detected in 24 ( 34.3% ) of 70 patients, and the atrial fibrillation recurrence ratio was higher in the Anagliptin group than in the Tofogliflozin group ( 15 of 32 patients [ 47% ] vs 9 of 38 patients [ 24% ]; P = 0.0417 ).

Moreover, univariate analysis revealed that compared with the nonrecurrence group ( n = 46 ), the recurrence group ( n = 24 ) had a higher prevalence rate of non-paroxysmal atrial fibrillation, elevated brain natriuretic peptide, higher urinary albumin-creatinine ratio, lower rate of SGLT2 inhibitors use, larger left atrial diameter, elevated E wave, lower left ventricular ejection fraction, and lower rate of cryoballoon pulmonary vein isolation.

In conclusion, compared with Anagliptin, Tofogliflozin has achieved greater suppression of atrial fibrillation recurrence after catheter ablation in patients with type 2 diabetes mellitus. ( Xagena )

Kishima H et al, JACC: Clinical Electrophysiology 2022; 8: 1405-1406