钠-葡萄糖协同转运蛋白2抑制剂对无2型糖尿病心力衰竭患者房颤导管消融的影响
Impact of sodium-glucose cotransporter 2 inhibitors on catheter ablation for atrial fibrillation in heart failure patients without type-2 diabetes.
作者信息
Harada Masahide, Motoike Yuji, Nomura Yoshihiro, Nishimura Asuka, Koshikawa Masayuki, Watanabe Eiichi, Ozaki Yukio, Izawa Hideo
机构信息
Department of Cardiology, Fujita Health University 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 4701192, Japan.
Department of Cardiology, Fujita Health University 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 4701192, Japan.
出版信息
Int J Cardiol. 2025 Mar 1;422:132954. doi: 10.1016/j.ijcard.2024.132954. Epub 2025 Jan 2.
BACKGROUND
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.
METHODS
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[-].
RESULTS
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[-].
CONCLUSION
Periprocedural SGLT2i treatment decreased LAP and improved the outcomes of catheter ablation for PeAF in HF patients without T2DM.
背景
据报道，钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）可降低2型糖尿病（T2DM）或心力衰竭（HF）患者新发房性心律失常的发生率。本研究探讨了SGLT2i对非T2DM的HF患者房颤（AF）导管消融的影响。
方法
前瞻性纳入102例接受导管消融的持续性AF（PeAF）且合并HF（脑钠肽前体N末端，NT-proBNP≥400 pg/ml）的非T2DM患者。51例患者（SGLT2i[+]组）在手术前≥1个月开始使用SGLT2i，并在随访期间持续使用；另外51例患者（SGLT2i[-]组）未使用SGLT2i。在开始导管消融前，通过置于左心房（LA）的鞘管测量左心房压力（LAP）。比较SGLT2i[+]组和SGLT2i[-]组早期及1年房性心律失常复发的无事件发生率。
结果
SGLT2i[+]组和SGLT2i[-]组的基线特征无显著差异。与SGLT2i[-]组相比，SGLT2i[+]组的平均LAP显著降低（9.3±4.8 mmHg vs. 12.1±6.6 mmHg，p<0.01）；SGLT2i[+]组LAP与体循环血压的比值也降低（0.11±0.05 vs. 0.15±0.07，p<0.01）。两组入选时的血清NT-proBNP水平无变化，但SGLT2i[+]组在导管消融当天（p=0.06）和术后1个月（p<0.01）的值低于SGLT2i[-]组。SGLT2i[+]组早期（92% vs. 60%，p<0.01）和1年（89% vs. 75%，p<0.05）房性心律失常复发的无事件发生率显著高于SGLT2i[-]组。
结论
围手术期SGLT2i治疗可降低LAP，并改善非T2DM的HF患者PeAF导管消融的效果。
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