SGLT2 inhibitors and the risk of atrial fibrillation recurrence within one year after radiofrequency ablation

Abstract

SGLT2 Inhibitors and the Risk of Atrial Fibrillation Recurrence Within One Year After Radiofrequency Ablation

Introduction: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with substantial morbidity and mortality. Catheter ablation (CA) has become an established rhythm-control strategy, yet recurrence remains frequent. Sodium–glucose cotransporter-2 inhibitors (SGLT2is) have become a cornerstone therapy for heart failure (HF) across all spectra of ventricular function. Growing evidence suggests that these agents may contribute to cardiac reverse remodeling, including potential effects on atrial structure and fibrosis. However their effect on the risk of AF recurrence after catheter ablation is not well defined.

Purpose: To evaluate the association between SGLT2is therapy and the risk of AF recurrence during the first year following high-power short-duration (HPSD) radiofrequency CA in patients with paroxysmal or persistent AF.

Methods: A retrospective analysis was performed on 196 consecutive patients who underwent HPSD CA for AF between 2021 and 2024. Clinical, echo-cardiographic, and procedural variables were collected. AF recurrence within 12 months was assessed using follow-up ECGs and Holter recordings. Associations between SGLT2is use and recurrence were analyzed using Chi-square testing and multivariable binary logistic regression including relevant covariates such as left atrial (LA) diameter, left ventricular ejection fraction (LVEF), and presence of low-voltage areas.

Results: Among the study population, 85 patients (43.4%) experienced AF recurrence at 1-year follow-up. SGLT2is were used by 29 patients (14.8%). In unadjusted analyses, SGLT2is therapy was associated with a higher recurrence rate. In the multivariable model incorporating clinical and procedural predictors, SGLT2is use prior to CA remained significantly associated with recurrence (OR 40.83, p = 0.002). However, SGLT2is status did not significantly predict the need for repeat ablation within 12 months in either univariate or multivariable models.

Conclusions: Although SGLT2is demonstrate substantial cardiovascular benefits in HF and chronic kidney disease, their influence on AF recurrence after catheter ablation remains uncertain. In this single-center retrospective cohort, pre-procedural SGLT2is therapy was independently associated with a higher likelihood of AF recurrence at one year, though it did not predict repeat ablation. These findings highlight the need for prospective, controlled studies to clarify the relationship between SGLT2is and post-ablation arrhythmia outcomes.