Effect of SGLT2 inhibitors on atrial fibrillation recurrence after catheter ablation in patients with type 2 diabetes in the United States: a TriNetX database study.

Abstract

Background: Atrial fibrillation (AF) is a common cardiac arrhythmia associated with significant morbidity and mortality, particularly in patients with type 2 diabetes mellitus (T2DM). Catheter ablation is a key treatment for AF, but recurrence rates remain high. Sodium-glucose cotransporter 2 inhibitors (SGLT2i), used for glycemic control in T2DM, have shown potential in reducing arrhythmias. This study investigates the effect of SGLT2i on AF recurrence after catheter ablation in T2DM patients.

Methods: We conducted a retrospective cohort study using the TriNetX Global Collaborative Network, identifying adults aged 18-80 years with type 2 diabetes mellitus (T2DM) who underwent catheter ablation for atrial fibrillation (AF) between 2013 and 2024. Patients were grouped by prior use of SGLT2 inhibitors. Propensity score matching (PSM) was applied on 66 covariates to balance baseline demographics, comorbidities, medications, laboratory values, and echocardiographic parameters. Outcomes included redo AF ablation, additional atrial ablation lines, electrical cardioversion, and anti-arrhythmic use.

Results: After PSM, 6,180 matched pairs were analyzed. SGLT2 inhibitor use was associated with a lower redo AF ablation rate (8.8% vs. 12.7%; RR 1.44, p < 0.001), fewer additional ablation procedures (4.6% vs. 5.7%, p = 0.021), and reduced anti-arrhythmic drug use (57.2% vs. 65.2%, p < 0.001). No significant difference was seen in electrical cardioversion rates.

Conclusion: Among T2DM patients undergoing AF ablation, SGLT2 inhibitor therapy was linked to reduced need for repeat ablation, fewer complex ablation procedures, and decreased reliance on anti-arrhythmic medications, suggesting a potential rhythm-stabilizing benefit.