Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA.
Division of Internal Medicine, Cleveland Clinic, Akron, Ohio, USA.
JACC Clin Electrophysiol. 2023 Oct;9(10):2109-2118. doi: 10.1016/j.jacep.2023.06.008. Epub 2023 Aug 9.
The effects of sodium-glucose cotransporter 2 inhibitors (SGLT2-Is) on recurrent atrial fibrillation (AF) among patients undergoing catheter ablation is not well described.
This study sought to assess the impact of SGLT2-Is on the recurrence of AF among patients with type 2 diabetes mellitus (DM) after catheter ablation.
Using the TriNetX research network, we identified, by means of Current Procedural Terminology codes, patients ≥18 years of age with type 2 diabetes mellitus (DM) who had undergone AF ablation from April 1, 2014, to November 30, 2021. Patients were stratified based on the baseline SGLT2-I use. Propensity-score matching resulted in 2,225 patients in each cohort. The primary outcome was a composite of cardioversion, new antiarrhythmic drug (AAD) therapy, or re-do AF ablation after a blanking period after the index ablation. Additional outcomes included heart failure exacerbations, ischemic stroke, all-cause hospitalization, and death during 12 months of follow-up.
SGLT2-I use in patients with type 2 DM undergoing AF ablation was associated with a significantly lower risk of cardioversion, new AAD therapy, and re-do AF ablation (adjusted OR: 0.68; 95% CI: 0.602-0.776; P < 0.0001). At 12 months, patients on SGLT2-Is had a higher probability of event-free survival (HR: 0.85, 95% CI: 0.77-0.95; log-rank test chi-square = 8.7; P = 0.003). All secondary outcomes were lower in the SGLT2I group; however, the ischemic stroke did not differ between groups.
Use of SGLT2-Is in patients with type 2 DM is associated with a lower risk of arrhythmia recurrence after AF ablation and thence a reduced need for cardioversion, AAD therapy, or re-do AF ablation.
钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2-Is）对接受导管消融的患者复发性心房颤动（AF）的影响尚不清楚。
本研究旨在评估 SGLT2-Is 对导管消融后 2 型糖尿病（DM）患者 AF 复发的影响。
使用 TriNetX 研究网络，通过当前程序术语（CPT）代码，我们确定了 2014 年 4 月 1 日至 2021 年 11 月 30 日期间年龄≥18 岁并接受过 AF 消融术的 2 型糖尿病（DM）患者。患者根据基线 SGLT2-I 使用情况进行分层。倾向评分匹配后，每个队列有 2225 例患者。主要结局是在指数消融后的空白期后，电复律、新抗心律失常药物（AAD）治疗或再次进行 AF 消融的复合终点。其他结局包括心力衰竭加重、缺血性中风、全因住院和 12 个月随访期间的死亡。
在接受 AF 消融术的 2 型 DM 患者中使用 SGLT2-Is 与电复律、新 AAD 治疗和再次进行 AF 消融的风险显著降低相关（调整后的 OR：0.68；95%CI：0.602-0.776；P<0.0001）。在 12 个月时，使用 SGLT2-Is 的患者无事件生存的可能性更高（HR：0.85，95%CI：0.77-0.95；对数秩检验卡方=8.7；P=0.003）。SGLT2I 组的所有次要结局均较低；然而，两组之间的缺血性中风没有差异。
在 2 型 DM 患者中使用 SGLT2-Is 与 AF 消融后心律失常复发风险降低相关，从而减少电复律、AAD 治疗或再次进行 AF 消融的需求。
