Use of SGLT2 Inhibitors in Patients With Type 2 DM Following Catheter Ablation for AF

Among patients with type 2 diabetes mellitus (DM) who receive ablation for atrial fibrillation (AF), use of sodium-glucose cotransporter 2 (SGLT2) inhibitors is associated with an increased likelihood of maintaining sinus rhythm, as well as lower rates of heart failure exacerbation, all-cause hospitalization, and all-cause mortality, according to a study in JACC: Clinical Electrophysiology.

The retrospective, propensity-matched cohort study analyzed the effects of SGLT2 inhibitors on AF recurrence in patients with type 2 DM who have received ablation for AF with use of data from the TriNetX Analytics Network database. Participants were aged 18 years or older with a history of type 2 DM and ablation for AF from April 1, 2014, to November 30, 2021.

The main composite outcome was the need for cardioversion, new class I or III antiarrhythmic drug (AAD) therapy, or re-do AF ablation after a 3-month blanking period following the index AF ablation. Participants were stratified into 2 cohorts according to their use of SGLT2 inhibitors at index ablation.

Of the participants with a history of type 2 DM who had received AF ablation, 10,974 were not receiving an SGLT2 inhibitor and 2366 were receiving an SGLT2 inhibitor. After propensity score matching, 2225 patients were in each group (mean age, 65±9 years; 82% White). In the non-SGLT2 inhibitor group, 26% of participants were women vs 25% in the SGLT2 inhibitor group.

The main composite outcome after the index AF ablation occurred in 619 patients in the SGLT2 inhibitor group vs 802 patients in the non-SGLT2 inhibitor group (adjusted odds ratio OR [aOR], 0.68; 95% CI, 0.602-0.776) after the 3-month blanking period. The likelihood of event-free survival at 12 months (66% vs 61%; P = .003; hazard ratio, 0.85; 95% CI, 0.77-0.95) was increased for the SGLT2 inhibitor group.

Patients in the SGLT2 inhibitor cohort had lower rates of cardioversion (aOR, 0.62; 95% CI, 0.49-0.80; P <.0001), new class I or III AAD use (aOR, 0.72; 95% CI, 0.63-0.82; P <.0001), and re-do ablations for AF (aOR, 0.71; 95% CI, 0.53-0.95; P =.022) 3 months after the index ablation. HF exacerbations (aOR, 0.81; 95% CI, 0.71-0.91; P =.001) and all-cause hospitalizations (aOR, 0.78; 95% CI, 0.68-0.91; P =.001) also were lower among patients who received SGLT2 inhibitors.

Patients on SGLT2 inhibitors had a lower all-cause mortality (aOR, 0.62; 95% CI, 0.41-0.93; P =.019).

Limitations of the study include residual unmeasured confounding in the observational study with use of retrospective data. In addition, an accurate incidence of recurrent AF after ablation may not have been obtained, because patients may have had recurrent AF after ablation but were not treated with cardioversion, AAD, or re-do ablation. Furthermore, social determinants of health and other unmeasurable confounding factors may have affected outcomes.

“…this retrospective analysis suggests that the use of SGLT2-Is [inhibitors] in patients with type 2 DM undergoing AF ablation is associated with a lower risk of needing subsequent cardioversion, new AAD therapy, and re-do AF ablation,” wrote the investigators. “This suggests that SGLT2-Is may increase the likelihood of maintaining sinus rhythm after AF ablation in patients with type 2 DM and AF.”

Disclosure: One of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.