Tofogliflozin Better Suppresses Post-Ablation AF in T2DM Than Anagliptin

Following catheter ablation, atrial fibrillation (AF) suppression is better achieved with tofogliflozin compared with anagliptin in patients with type 2 diabetes mellitus. These findings were published in JACC: Clinical Electrophysiology.

Patients (N=70) with type 2 diabetes mellitus who were referred for catheter ablation of AF to the Hyogo College of Medicine in Japan between 2017 and 2020 were recruited for this prospective, single-center, open-label, randomized controlled trial. The rate of AF suppression following catheter ablation was evaluated among patients randomly assigned to receive 20 mg tofogliflozin once daily (n=38) or 100 mg anagliptin twice daily (n=32) for 2 to 6 weeks prior to catheter ablation and during the 1-year follow-up.

The study participants were had a mean age of 70.3±8.2 years, 69% were men, average body mass index (BMI) was 25.4 (SD, 4.5), 57% had nonparoxysmal AF, they had AF for 38.5 (SD, 47.7) months, 64% had hypertension, 64% dyslipidemia, and 31% were receiving antidiabetic drugs. No significant group differences were observed at baseline.

After exposure to interventional drugs, the tofogliflozin recipients had greater improvements in waist circumference, BMI, systolic and diastolic blood pressure, urinary excretion of sodium and potassium, total serum ketones, and b-hydroxybutyrate acid at 12 months compared with baseline.

All patients had successful pulmonary vein isolation (PVI) and most (74%) received radiofrequency PVI. An additional cavotricuspid isthmus ablation was performed among 71% of patients and an additional superior vena cava isolation was performed among 17% of patients. Sinus rhythm was achieved among all patients following intervention.

The AF recurrence ratio was higher among the anagliptin recipients (47%) than tofogliflozin recipients (24%; P =.0417). Freedom from AF recurrence favored tofogliflozin in the intention-to-treat (P =.0377) and per-protocol (P =.0415) analyses.

No thromboembolic events were observed during the follow-up.

Stratified by recurrence (n=24) and no recurrence (n=46), predictors for recurrence included the following:

• Presence of nonparoxysmal AF (92% vs 39%; P <.0001)
• Left ventricular ejection fraction (mean, 52.6% vs 63.7%; P =.0007)
• Brain natriuretic peptide levels (mean, 304.9 vs 144.2 pg/mL; P =.0025)
• Left atrial diameter (mean, 48.4 vs 43.6 mm; P =.0026)
• E wave length (mean, 87.4 vs 74.5 cm/s; P =.0091)
• Urinary microalbumin levels (mean, 182.6 vs 50.8 mg/mL; P =.0123)
• Use of cryoballoon PVI (8% vs 35%; P =.0207)
• Urinary albumin-creatinine ratio (mean, 195.9 vs 73.7; P =.0395)
• Use of sodium-glucose cotransporter 2 inhibitors (SGLT2i; 37% vs 63%; P =.0417)
• Use of dipeptidyl peptidase-4 inhibitors (63% vs 37%; P =.0417)

The major limitation of this study is that a multivariate analysis cannot be performed due to the small sample size.

“A comparison of the effects of tofogliflozin and anagliptin on the suppression of recurrence of AF after CA [catheter ablation] in patients with type 2 DM [diabetes mellitus] revealed that tofogliflozin, and SGLT2i, was associated with a significantly lower risk of recurrent AF,” the study authors wrote.