Impact of sodium-glucose cotransporter-2 inhibitors on recurrence after atrial fibrillation ablation in patients with indications for SGLT2i therapy
A Castro Pinto, B Resende, E Mata, B Lage Garcia, M Castro, S Ribeiro, J Gameiro, F Cordeiro, L Goncalves, A LourencoAbstract
Background
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are associated with cardiovascular benefits that extend beyond glycemic control, including reductions in heart failure events and atrial fibrillation (AF) incidence. Whether these pleiotropic effects translate into improved rhythm outcomes after catheter ablation in patients with a pre-existing indication for SGLT2i therapy is a topic of ongoing investigation.
Purpose
To systematically evaluate the impact of SGLT2i therapy in patients undergoing AF ablation with prior indication for SGLT2i treatment.
Methods
A systematic search (December 2025) of PubMed, Cochrane Library, Scopus, and Web of Science identified observational studies and randomized data comparing outcomes in patients treated with SGLT2i versus controls after AF catheter ablation. Eligible studies included patients with guideline-based indications for SGLT2i. The primary outcome was AF recurrence and redo ablation. Secondary outcomes comprised all-cause mortality, all-cause hospitalization, and atrial arrhythmia recurrence. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using inverse-variance random-effects models. Heterogeneity was assessed with the I² statistic.
Results
From 192 screened records, 9 observational studies published between 2022 and 2025 were included, encompassing 18974 patients. SGLT2i therapy was associated with a significant reduction in AF recurrence after catheter ablation (RR 0.61, 95% CI 0.52-0.70; I²=0%). The need for redo ablation was not significantly different (RR 0.25, 95% CI 0.03-1.87; I²=64%). SGLT2i use was associated with lower all-cause mortality (RR 0.64, 95% CI 0.45-0.91; I²=0%) and reduced all-cause hospitalization (RR 0.82, 95% CI 0.74-0.92; I²=0%). A significant reduction in atrial arrhythmia recurrence was also observed (RR 0.53, 95% CI 0.42-0.66; I²=0%). Across analyses, treatment effects were consistent with low heterogeneity except for the need for redo ablation.
Conclusions
In patients with an established indication for SGLT2i undergoing AF catheter ablation, SGLT2i therapy is associated with a reduction in AF and atrial arrhythmia recurrence, alongside lower mortality and hospitalization rates. Although a reduction in redo ablation did not reach statistical significance, these findings suggest a clinically meaningful adjunctive role for SGLT2i in rhythm control strategies after AF ablation.