The Impact of SGLT2 Inhibitors on Atrial Fibrillation Recurrence and Long-Term Clinical Outcomes in HFrEF Patients Undergoing Cryoballoon Ablation: A New Frontier Beyond Diabetes and Heart Failure.

Background: Atrial fibrillation (AF) recurrence remains a significant challenge in heart failure with reduced ejection fraction (HFrEF) patients undergoing cryoballoon ablation (CBA). Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated cardiovascular benefits, including antiarrhythmic effects. This study assesses the impact of SGLT2i on AF recurrence and clinical outcomes in HFrEF patients undergoing CBA.

Methods: This retrospective cohort study was conducted on 246 HFrEF patients (LVEF < 40%) undergoing CBA between January 2022 and June 2024. Patients were categorized into two groups: SGLT2i users (n = 71) and nonusers (n = 175). The primary endpoint was AF recurrence (> 30 s post-blanking period). Secondary endpoints included all-cause mortality and heart failure (HF)-related hospitalizations.

Results: The median follow-up period was 347 days. AF recurrence was lower in the SGLT2i group (25.4% vs. 39.4%, p = 0.036). Kaplan-Meier analysis demonstrated higher recurrence-free survival in SGLT2i users (74.6% vs. 60.6%, log-rank p < 0.001). Cox regression confirmed SGLT2i as an independent predictor of reduced AF recurrence (HR: 0.546, 95% CI: 0.262-0.874, p = 0.011). Mortality (9.9% vs. 14.9%, p = 0.039) and HF hospitalizations (16.9% vs. 23.4%, p = 0.014) were also significantly lower in SGLT2i users.

Conclusion: SGLT2i use was independently associated with lower AF recurrence, mortality, and HF-related hospitalizations in HFrEF patients undergoing CBA. These findings highlight the potential of SGLT2i as adjunctive therapy for AF management, necessitating further prospective studies to validate these results and optimize treatment strategies.