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Research Article: The effects of SGLT2 inhibitors on atrial fibrillation recurrence and cardiac function after catheter ablation in patients with atrial fibrillation and heart failure: a retrospective cohort study and meta-analysis

Date Published: 2026-05-01

Abstract:
The impact of Sodium-glucose cotransporter 2 inhibitors (SGLT2i) on postoperative atrial fibrillation (AF) recurrence and cardiac function in patients with AF and heart failure (HF) undergoing catheter ablation remains unclear. This study comprised two parts. Part 1 was a retrospective cohort study involving 168 patients with AF and HF who underwent first-time catheter ablation (SGLT2i group: n =?83; non-SGLT2i group: n =?85). Atrial arrhythmia recurrence rate was significantly lower in the SGLT2i group compared to the non-SGLT2i group (13.25% vs. 25.88%, P =?0.039). Multivariate Cox proportional hazards regression analysis identified severe atrial fibrosis (HR 2.80, 95% CI: 1.13–6.96, P =?0.026) and SGLT2i use (HR 0.45, 95% CI: 0.22–0.94, P =?0.033) as independent predictors of atrial arrhythmia recurrence. At 12-month follow-up, SGLT2i group had a smaller left atrial diameter (LA: 37.37?±?4.25?mm vs. 39.25?±?6.22?mm, P =?0.024) and a higher left ventricular ejection fraction (LVEF: 62.06?±?11.39% vs. 58.89?±?7.98%, P =?0.039). Part 2 was a meta-analysis. We systematically searched and included 13 studies-2 RCTs and 11 retrospective cohort studie, involving 7,954 patients (SGLT2i: 3518; non-SGLT2i: 4436). Results indicated that SGLT2i significantly reduced the risk of atrial arrhythmia recurrence after catheter ablation (RR?=?0.59, 95% CI: 0.51–0.69, P <?0.001). Furthermore, SGLT2i was associated with reduced risks of all-cause mortality (RR: 0.66, 95% CI: 0.48–0.91, P =?0.011). In patients with AF and HF, SGLT2i use is associated with a lower risk of AF recurrence after catheter ablation and with improvements in cardiac structure and function. SGLT2i is also associated with lower risks of all-cause mortality, rehospitalization, and HF events.

Introduction:
Atrial fibrillation (AF) can induce heart failure (HF) or exacerbate pre-existing HF. Studies show that up to 30% of patients present with both conditions. HF patients often have a poor prognosis, with a 5-year survival rate of less than 50% ( 1 ). For patients with coexisting HF and AF, achieving long-term sinus rhythm maintenance and improving cardiac function remain critical and challenging clinical goals. Catheter ablation (CA), as a first-line treatment for AF, has been widely adopted in clinical practice ( 2…

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