Impact of sodium-glucose cotransporter 2 inhibitors on catheter ablation for atrial fibrillation in heart failure patients without type-2 diabetes

Sodium-glucose cotransporter 2 inhibitors (SGLT2is) reportedly decreased the new-onset atrial arrhythmias in patients with type-2 diabetes (T2DM) or heart failure (HF). This study examined the impact of SGLT2is on catheter ablation for atrial fibrillation (AF) in HF patients without T2DM. Persistent AF (PeAF) and HF (N-terminal prohormone of brain natriuretic peptide, NT-proBNP ≥400 pg/ml) patients without T2DM undergoing catheter ablation were prospectively enrolled (n = 102). SGLT2is were prescribed from ≥1 month prior to the procedure and were continued during the follow-up in 51 patients (SGLT2i[+]) but not prescribed in 51 patients (SGLT2i[-]). Left atrial pressure (LAP) was measured via the sheath placed in the LA before starting catheter ablation. The event-free rate of early and 1-year atrial-arrhythmia recurrence were compared between SGLT2i[+] and SGLT2i[-]. There was no significant difference in baseline characteristics between SGLT2i[+] and SGLT2i[-]. SGLT2i[+] significantly decreased average LAP compared to SGLT2i[-] (9.3 ± 4.8 mmHg vs. 12.1 ± 6.6 mmHg, p < 0.01); normalized LAP to systemic blood pressure also decreased in SGLT2i[+] (0.11 ± 0.05 vs. 0.15 ± 0.07, p < 0.01). The serum NT-proBNP levels at the enrollment were unchanged between the two groups but SGLT2i[+] had lower values on the day of catheter ablation (p = 0.06) and at 1 month after the procedure (p < 0.01) than SGLT2i[-]. SGLT2i[+] had significantly higher event-free rate of early (92 % vs. 60 %, p < 0.01) and 1-year (89 % vs. 75 %, p < 0.05) atrial-arrhythmia recurrence than SGLT2i[-]. Periprocedural SGLT2i treatment decreased LAP and improved the outcomes of catheter ablation for PeAF in HF patients without T2DM.