钠-葡萄糖协同转运蛋白2抑制剂对心力衰竭患者心房颤动消融术后预防房性心律失常复发的疗效。

Efficacy of sodium-glucose cotransporter 2 inhibitors on preventing atrial arrhythmia recurrences after atrial fibrillation ablation in patients with heart failure.

作者信息

Okajima Takashi, Ishikawa Shinji, Uemura Yusuke, Ozaki Yuta, Yamaguchi Shogo, Mitsuda Takayuki, Takemoto Kenji, Inden Yasuya, Murohara Toyoaki, Watarai Masato

机构信息

Department of Cardiology, Anjo Kosei Hospital, Anjo, Japan.

出版信息

J Cardiol. 2025 Mar 19. doi: 10.1016/j.jjcc.2025.03.013.

DOI:10.1016/j.jjcc.2025.03.013

PMID:40118337

Abstract

BACKGROUND

Atrial fibrillation (AF) is frequently observed in patients with heart failure (HF), and the efficacy of catheter ablation for AF treatment has been established; however, recurrence of atrial arrhythmia is possible. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been reported to suppress AF recurrence in patients with diabetes; however, the efficacy of SGLT2i after AF ablation in patients with HF has not been fully elucidated.

METHODS

A total of 141 consecutive patients with HF aged ≤75 years who underwent AF ablation were analyzed. Patients with follow-up shorter than six months were excluded. The primary endpoint was atrial arrhythmia recurrence after a 3-month blanking period. The type of recurrence, incidence of hospitalization for HF, and mortality rates were also evaluated.

RESULTS

Forty-five patients used SGLT2i, and the median follow-up period was 372 days. The incidence of atrial arrhythmia recurrence was significantly lower in patients taking SGLT2i than in those that were not taking SGLT2i (20.0 % vs. 38.5 %, p = 0.029; log-rank test, p = 0.034). In the multivariate analysis, intake of SGLT2i was associated with a low risk of atrial arrhythmia recurrence (hazard ratio: 0.38, 95 % confidence interval: 0.18-0.80, p = 0.010). The rate of AF recurrence was significantly lower than the rate of atrial tachycardia/flutter recurrence in the SGLT2i group (44.4 % vs. 83.8 %; p = 0.013). The incidence of hospitalization for HF and/or death was low in both groups (0 % in the SGLT2i group and 1.0 % in the non-SGLT2i group). In 24 propensity score-matched pairs, the SGLT2i group had a lower recurrence rate (16.7 % vs. 45.8 %, p = 0.029, log-rank test, p = 0.047) than the non-SGLT2i group.

CONCLUSIONS

SGLT2i use in patients with HF was associated with a lower atrial arrhythmia recurrence after AF ablation; hence, SGLT2i administration for patients with HF who will undergo AF ablation may be beneficial.

摘要

背景

心房颤动（AF）在心力衰竭（HF）患者中很常见，导管消融治疗AF的疗效已得到证实；然而，房性心律失常仍有可能复发。据报道，钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）可抑制糖尿病患者的AF复发；然而，SGLT2i在HF患者AF消融后的疗效尚未完全阐明。

方法

对141例年龄≤75岁接受AF消融的连续性HF患者进行分析。排除随访时间短于6个月的患者。主要终点是3个月空白期后的房性心律失常复发。还评估了复发类型、HF住院发生率和死亡率。

结果

45例患者使用SGLT2i，中位随访期为372天。服用SGLT2i的患者房性心律失常复发率显著低于未服用SGLT2i的患者（20.0%对38.5%，p = 0.029；对数秩检验，p = 0.034）。在多变量分析中，服用SGLT2i与房性心律失常复发风险低相关（风险比：0.38，95%置信区间：0.18 - 0.80，p = 0.010）。SGLT2i组AF复发率显著低于房性心动过速/心房扑动复发率（44.4%对83.8%；p = 0.013）。两组HF住院和/或死亡发生率均较低（SGLT2i组为0%，非SGLT2i组为1.0%）。在24对倾向评分匹配的病例中，SGLT2i组的复发率低于非SGLT2i组（16.7%对45.8%，p = 0.029，对数秩检验，p = 0.047）。