Impact of Sodium-Glucose Cotransporter 2 Inhibitor on Recurrence After Catheter Ablation for Atrial Fibrillation in Patients With or Without Metabolic Syndrome

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Data may be preliminary. 16 June 2025 V1 Latest version Share on Impact of Sodium-Glucose Cotransporter 2 Inhibitor on Recurrence After Catheter Ablation for Atrial Fibrillation in Patients With or Without Metabolic Syndrome Authors : Yang Xu , Zixu Zhao , Hui Xu , Chao Jiang , Xiao Wang , Zejun Yang , Wenyu Shao , … Show All … , Hang Guo , Liu He , Qi Guo , Caihua Sang , Deyong Long 0000-0003-4604-5346 , Xin Du , Jian zeng Dong 0000-0001-7299-7805 , and Chang Sheng Ma 0000-0001-6966-6239 [email protected] Show Fewer Authors Info & Affiliations https://doi.org/10.22541/au.175010483.33807147/v1 Published Journal of Cardiovascular Electrophysiology Version of record Peer review timeline 337 views 187 downloads Contents Abstract Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Aims: The impact of sodium-glucose cotransporter-2 inhibitors (SGLT2i) on atrial fibrillation (AF) recurrence after catheter ablation is still inconclusive. Besides, their efficacy on AF recurrence stratified by metabolic syndrome (MetS) status remains unknown. Methods: Patients with AF undergoing initial catheter ablation between January 2017 and December 2023 from the China-AF Registry were included. Patients were 1:1 propensity score-matched by SGLT2i use at discharge and stratified by baseline MetS status. The main outcome was the AF recurrence after a 3-month blanking period. Results: After propensity score matching, 573 patients in the SGLT2i group and 573 in the non-SGLT2i group were included in the study. During the 20.5 ± 13.7 months follow-ups, AF recurrence occurred in 100 patients (17.5%) in the SGLT2i group and 168 patients (29.3%) in the non-SGLT2i group. SGLT2i was associated with lower AF recurrence (17.5% vs. 29.3%; HR 0.59, 95% CI 0.46–0.75, P <0.001), with consistent benefits in MetS (HR 0.61, 95% CI 0.39–0.75, P =0.03) and non-MetS subgroups (HR 0.58, 95% CI 0.43–0.78, P <0.001, P interaction =0.841). The effect of SGLT2i on the AF recurrence also remained consistent across the Body mass index (BMI) spectrum ( P interaction =0.740). Conclusion: SGLT2i was associated with a lower risk of AF recurrence after catheter ablation independently of MetS status or BMI spectrum. Impact of Sodium-Glucose Cotransporter 2 Inhibitor on Recurrence After Catheter Ablation for Atrial Fibrillation in Patients With or Without Metabolic Syndrome Yang Xu*, MS 1 , Zixu Zhao*, MD 1 , Hui Xu*, MS 1 , Chao Jiang, MD 1† , Xiao Wang, MD 2† , Zejun Yang, MS 1 , Wenyu Shao, MS 1 , Hang Guo, MS 1 , Liu He, PhD 1 , Qi Guo, MD 1 , Caihua Sang, MD 1 , Deyong Long, MD 1 , Xin Du, MD 1,3 , Jianzeng Dong, MD 1 , Changsheng Ma, MD 1† *The authors contributed equally to the study. 1 Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China 2 Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China 3 Heart Health Research Center, Beijing, China ACKNOWLEDGEMENTS This study is supported by Beijing Municipal Health Commission, Capital Health Development Research Project (2024-4-20610) and Beijing Physician Scientist Training Project (BJPSTP-2024-21). DISCLOSURE None reported. Address for correspondence: Chao Jiang, E-mail: [email protected] ; Changsheng Ma, E-mail: [email protected] . Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No.2, Anzhen Road, Chaoyang District, 100029 Beijing, China. Xiao Wang, E-mail: [email protected] ; Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167A Beilishi Road, Xicheng District, Beijing 100037, China Total words count: 2430 (including abstract and the main body of the text) This article includes thirty-four references, one table and four figures. ABSTRACT Aims: The impact of sodium-glucose cotransporter-2 inhibitors (SGLT2i) on atrial fibrillation (AF) recurrence after catheter ablation is still inconclusive. Besides, their efficacy on AF recurrence stratified by metabolic syndrome (MetS) status remains unknown. Methods: Patients with AF undergoing initial catheter ablation between January 2017 and December 2023 from the China-AF Registry were included. Patients were 1:1 propensity score-matched by SGLT2i use at discharge and stratified by baseline MetS status. The main outcome was the AF recurrence after a 3-month blanking period. Results: After propensity score matching, 573 patients in the SGLT2i group and 573 in the non-SGLT2i group were included in the study. During the 20.5 ± 13.7 months follow-ups, AF recurrence occurred in 100 patients (17.5%) in the SGLT2i group and 168 patients (29.3%) in the non-SGLT2i group. SGLT2i was associated with lower AF recurrence (17.5% vs. 29.3%; HR 0.59, 95% CI 0.46–0.75, P <0.001), with consistent benefits in MetS (HR 0.61, 95% CI 0.39–0.75, P =0.03) and non-MetS subgroups (HR 0.58, 95% CI 0.43–0.78, P <0.001, P interaction =0.841). The effect of SGLT2i on the AF recurrence also remained consistent across the Body mass index (BMI) spectrum ( P interaction =0.740). Conclusion: SGLT2i was associated with a lower risk of AF recurrence after catheter ablation independently of MetS status or BMI spectrum. Keywords: Atrial fibrillation, Catheter ablation, Sodium-glucose cotransporter-2 inhibitors, Metabolic syndrome, Body mass index. Abbreviations: AF: Atrial fibrillation SGLT: Sodium-glucose cotransporter-2 MetS: Metabolic syndrome BMI: Body mass index PSM: Propensity score matching ECG: Electrocardiogram eGFR: Estimated glomerular filtration rate HR: Hazard ratios CI: Confidence interval RCS: Restricted cubic splines Atrial fibrillation (AF) affects over 33.5 million individuals globally 1 and significantly increases risks of mortality, stroke, and heart failure while straining healthcare systems 2 . Approximately half of patients with AF suffer from metabolic comorbidities like hypertension, diabetes, or obesity 3 . Catheter ablation is the first-line therapy for rhythm control in AF patients, while AF recurrence remains common, occurring in approximately 30%–40% of cases 3 , especially worsened by comorbid metabolic syndrome (MetS). Several studies and meta-analyses have shown that patients with MetS have higher rates of AF recurrence after catheter ablation than those without MetS 4-7 , likely due to atrial structural and electrical remodeling associated with metabolic dysfunction 8, 9 . These data highlight the need for adjunctive therapies that can improve ablation outcomes, especially in populations with MetS. Sodium-glucose cotransporter 2 (SGLT2) inhibitors, originally developed for diabetes, have demonstrated cardiovascular and metabolic benefits beyond glucose lowering 10, 11 . Whereas, the impact of SGLT2 inhibitors on AF recurrence is still inconclusive. Previous studies demonstrated that SGLT2 inhibitors were associated with lower AF recurrence after catheter ablation in diabetic 12 or heart failure patients 13 . Recent meta-analyses confirm this association between SGLT2 inhibitors and AF recurrence 14 . Besides, whether these potential antiarrhythmic effects are modified by the presence or absence of MetS remains uncertain. Therefore, leveraging data from the China-AF registry, a multicenter prospective cohort study, this study aimed to assess the efficacy of SGLT2 inhibitors in reducing AF recurrence after catheter ablation among patients with and without metabolic syndrome. METHODS Method Study Population The China-AF Registry is a prospective, multicenter study designed to collect real-world data from patients with AF across 32 hospitals in Beijing, China (NCT06987825). The study was approved by the Ethics Committee of Beijing Anzhen Hospital (No. D11110700300000), and the rationale and design of the study were published previously 15 . All participants provided written informed consent before enrollment. Patients who underwent an initial catheter ablation procedure for AF were included in the current analysis. Key exclusion criteria comprised: (1) incomplete 12-month follow-up data, (2) documented congenital heart disease or cardiomyopathy (including dilated or hypertrophic cardiomyopathy), and (3) valvular AF. The study adheres to the ethical principles of the Declaration of Helsinki. Variable Definitions and Data Collection Baseline data were systematically extracted from medical records and entered into an electronic case report form using an electronic data capture system operated by trained abstractors. Collected data included demographic characteristics, AF characteristics, comorbidities (e.g., hypertension, diabetes, stroke), CHA₂DS₂-VA scores, laboratory parameters and echocardiographic findings. MetS was defined by the presence of at least three of the following five criteria 16 : (1) central obesity (in the absence of waist circumference data, a BMI ≥28 kg/m² was used as a surrogate); (2) hypertriglyceridemia (triglycerides ≥1.7 mmol/L); (3) low high density lipoprotein cholesterol (fasting high density lipoprotein cholesterol (5) diagnosed and treated hypertension. Participants were classified into the SGLT2 inhibitors group or the non-SGLT2 inhibitors group based on the use of SGLT2 inhibitors at discharge. Catheter Ablation and Pharmacological Treatment All ablation procedures were guided by a three-dimensional electroanatomical mapping system (CARTO 3, Biosense-Webster, Inc., Diamond Bar, CA, USA). The ablation strategies employed by participating centers have been described previously. All patients underwent circumferential pulmonary vein isolation. For those with persistent AF, additional linear ablations were performed at the left atrial roof, mitral isthmus, or tricuspid isthmus following pulmonary vein isolation. The procedural endpoint was defined as complete pulmonary vein isolation and bidirectional conduction block across all linear lesions. Antiarrhythmic drugs were discontinued three months after ablation. The choice and dosage of antiarrhythmic agents were left to the discretion of the treating physicians. All patients received anticoagulation therapy for a minimum of 3 months following catheter ablation. Subsequent continuation of anticoagulation was at the physician’s discretion, guided by individualized clinical assessment. Follow-up and Outcomes All participants in the registry were followed at outpatient clinics or by telephone interview at the 3rd, 6th month, and every 6 months thereafter. Standard 12-lead electrocardiogram (ECG) or 24-hour Holter monitoring was routinely performed during each scheduled follow-up. All clinical data were centrally adjudicated by experienced cardiologists from Beijing Anzhen Hospital. Recurrence of AF was defined as any documented atrial tachyarrhythmia episode lasting >30 seconds, confirmed by ECG or Holter monitoring after the 3-month blanking period. Statistical Analysis Continuous variables were expressed as mean ± standard deviation or median with interquartile range, as appropriate. Categorical variables were presented as frequencies and percentages. Between-group comparisons were performed using the independent-sample t-test or Wilcoxon rank-sum test for continuous variables, and the χ² test for categorical variables. To minimize potential confounding due to baseline differences between the SGLT2 inhibitors and non-SGLT2 inhibitors groups, 1:1 propensity score matching (PSM) was performed. Variables included in the propensity score model were: age, sex, BMI, history of heart failure, diabetes, chronic kidney disease, hypertension, presence of MetS, and estimated glomerular filtration rate (eGFR). The matched cohort was further stratified by the presence or absence of MetS at baseline. Kaplan-Meier curves and the log-rank test were used to compare outcomes between groups. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using univariate Cox proportional hazards models. Subgroup analysis of the association between SGLT2 inhibitor and AF recurrence was performed using stratified factors, including sex (male/female), BMI (<24, 24-28, or ≥28), age (≤70 years or chronic kidney disease, diabetes mellitus, hypertention. Interaction p-values were calculated, and a two-sided p-value <0.05 was considered statistically significant. We used restricted cubic splines (RCS) with four knots (5th, 35th, 65th, 95th percentiles) in Cox models to assess the nonlinear relationship between baseline BMI and AF recurrence, testing for interaction with SGLT2 inhibitors use. HRs for AF recurrence were calculated across the BMI distribution using the cohort-specific median BMI (23.5 kg/m²) as the reference point. All statistical analyses were performed using R software (version 4.4.3). RESULTS Baseline Characteristics A total of 9,645 AF patients met the inclusion criteria among patients enrolled in the China-AF Registry between January 2017 and December 2023, of whom 699 received SGLT2 inhibitor therapy after initial catheter ablation. In the SGLT2 inhibitors group, 126 patients were further excluded due to unsuccessful matching with the non-SGLT2 inhibitors group. The final matched cohort comprised 573 SGLT2 inhibitors-treated patients and 573 propensity-matched controls from the non-SGLT2 inhibitors population ( Figure 1 ). Baseline characteristics before and after matching are summarized in Supplementary Table 1 . After PSM, satisfactory between-group balance was achieved, as evidenced by standardized mean differences below 0.1 for majority of matched variables ( Supplementary Figure 1 ). Within the matched cohort, 377 patients were diagnosed with MetS, of whom 183 received SGLT2 inhibitors therapy; the remaining 769 patients without MetS included 390 SGLT2 inhibitors-treated individuals. Baseline characteristics stratified by treatment allocation for both patient subgroups are presented in Table 1 AF Recurrence During a median follow-up of 20.5 ± 13.7 months, AF recurrence occurred in 100 patients (17.5%) receiving SGLT2 inhibitors and 168 patients (29.3%) in the non-SGLT2 inhibitors group. Kaplan-Meier curves for AF recurrence-free survival are shown in Figure 2. The SGLT2 inhibitors group exhibited a significantly lower risk of AF recurrence compared to the non-SGLT2 inhibitors group (HR, 0.59, [95% CI 0.46–0.75], P <0.001). The log-rank test demonstrated a statistically significant difference in survival between the two groups ( P <0.001). Among patients with MetS, 31 AF recurrences occurred in the SGLT2 inhibitors group versus 52 events in non-SGLT2 inhibitors users (HR 0.61, 95% CI 0.39–0.75, P =0.03). Besides the non-MetS subgroup showed 69 recurrences with SGLT2 inhibitors therapy compared to 116 events without (HR 0.58, 95% CI 0.43–0.78, P <0.001). Subgroup Analysis Subgroup analyses evaluated treatment heterogeneity across sex, age strata, BMI categories, MetS status, AF subtype, chronic kidney disease, diabetes mellitus, and hypertension history ( Figure 3 ). A uniform treatment benefit favoring SGLT2 inhibitors over non-SGLT2 inhibitors therapy was observed across all subgroups for AF recurrence reduction. Notably, no significant interaction was observed between SGLT2 inhibitor treatment and MetS status ( P interaction =0.841). Similarly, comparative effectiveness analyses by BMI revealed non-significant trends ( P interaction =0.858) toward enhanced efficacy in underweight (BMI <24, HR 0.54, 95% CI 0.32–0.90, P =0.018) and obese (BMI ≥28, HR 0.56, 95% CI 0.36–0.86, P =0.009) subgroups relative to overweight individuals (24≤BMI<28, HR 0.63, 95% CI 0.43–0.91, P =0.015). Furthermore, RCS analysis demonstrated a U-shaped BMI-AF recurrence association (Supplementary Figure 1, P nonlinearity =0.711). Figure 4 demonstrates no significant interaction between baseline BMI and SGLT2 inhibitors efficacy for AF recurrence prevention ( P interaction =0.740). DISCUSSION Our study demonstrates SGLT2 inhibitors was associated with a low risk of AF recurrence after catheter ablation. Comparable benefits were observed in MetS and non-MetS subgroups, with no significant interaction. SGLT2 inhibitors consistently reduced AF recurrence across a broad BMI spectrum. The antiarrhythmic impact of SGLT2 inhibitors in patients after AF ablation has been previously investigated, mostly in patients with diabetes mellitus 12, 17, 18 . Growing evidence have begun to expand the application population of SGLT2 inhibitors in improving the recurrence of AF. In patients with heart failure undergoing catheter ablation for AF, SGLT2 inhibitor use was associated with a significantly lower risk of AF recurrence and improved composite cardiovascular outcomes 13 . In our study, the observed reduction in AF recurrence aligns with recent trials demonstrating SGLT2i’s efficacy in improving arrhythmia-free survival after catheter ablation. These benefits are likely mediated through multifaceted mechanisms, including weight reduction, blood pressure control, and attenuation of pro-fibrotic signaling 19 . For instance, sustained weight loss has been shown to reverse atrial remodeling, a mechanism corroborated by studies linking BMI reduction to lower AF burden 20, 21 . MetS increases the risk of AF occurrence and recurrence independently of traditional risk factors (such as age and hypertension) through mechanisms such as promoting inflammation, oxidative stress, insulin resistance and atrial fibrosis 22-24 . Previous studies have emphasized the crucial role of metabolic disorders in the persistence of atrial arrhythmias. SGLT2 inhibitors can improve metabolically relevant parameters such as waist circumference, body weight, and fasting plasma glucose, suggesting their potential to indirectly reduce cardiovascular risk by ameliorating components of MetS 25 . Notably, our study extends these observations by demonstrating that SGLT2 inhibitors’ antiarrhythmic effects persist even in non-MetS populations, underscoring their broader therapeutic potential beyond metabolic correction. Our findings reveal that SGLT2 inhibitors uniformly reduce post-ablation arrhythmia risk across diverse anthropometric profiles—from normal weight to extreme obesity (BMI ≥40 kg/m²), suggesting that the cardiac protective effect of SGLT2 inhibitors may not be affected by baseline BMI. Existing evidence demonstrates that the cardiovascular benefits of SGLT2 inhibitors in reducing major adverse cardiovascular events remain consistent across the BMI spectrum, with no significant interaction observed between BMI categories 26, 27 . Our independent efficacy of metabolic status suggests that SGLT2 inhibitors may reduce the recurrence of AF through non-metabolic mechanisms. First, SGLT2 inhibitors improve mitochondrial function by reducing reactive oxygen species overproduction and enhancing AMPK-PGC-1α signaling, as demonstrated in diabetic models where empagliflozin restored mitochondrial respiration and suppressed arrhythmogenic calcium handling abnormalities 28, 29 . This mitochondrial rescue may counteract atrial oxidative stress, a critical driver of electrical remodeling and triggered activity, even in non-diabetic patients. Second, SGLT2 inhibitors directly modulate ion channel activity. Dapagliflozin was shown to inhibit atrial Nav1.5 sodium channels, reducing cardiomyocyte excitability and triggered arrhythmias, while augmenting background potassium currents (K2P2.1/K2P17.1) to stabilize repolarization 19, 30 . Such ion channel effects could explain their efficacy across different BMI categories, as electrical remodeling is a universal AF substrate. Third, SGLT2 inhibitors mitigate structural remodeling by suppressing NLRP3 inflammasome activation and profibrotic pathways (e.g., TGF-β1, CTGF) 31, 32 . Finally, hemodynamic benefits from osmotic diuresis and afterload reduction may synergize with these cellular effects by reducing atrial wall stress 33 . These multimodal mechanisms converge to confer metabolic status-independent cardio-protection and antiarrhythmic efficacy across diverse AF populations. In the future, prospective randomized trials are warranted to confirm these findings and elucidate mechanisms. Mechanistic studies should prioritize SGLT2 inhibitors effects on atrial electrophysiology, inflammation, and fibrosis in MetS versus non-MetS models. Additionally, investigations into BMI-specific pharmacokinetics and tissue penetration could clarify attenuated efficacy at BMI extremes. Limitations Despite PSM used to balance baseline covariates, the observational nature of this study may introduce potential residual confoundings from unmeasured variables, such as lifestyle factors (e.g., diet, exercise patterns) and incomplete MetS criteria documentation (e.g., missing waist circumference data). Furthermore, asymptomatic atrial arrhythmias may have resulted in underestimation of AF recurrence rates, though this misclassification is likely nondifferential between groups, minimizing bias. Finally, the median follow-up duration of 14.3 months precludes definitive conclusions regarding the durability of SGLT2 inhibitors benefits. Prospective randomized trials with extended follow-up are needed to confirm our findings. Conclusion Our prospective, multicenter study showed that SGLT2 inhibitors was associated with a lower risk of AF recurrence after catheter ablation. 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Cardiovasc Res . 2018;114:12-18. legends to figures Figure 1. Flow chart Abbreviations: AF=Atrial fibrillation; SGLT2i=Sodium-glucose cotransporter-2 inhibitors; MS=Metabolic syndrome Figure 2. Kaplan-Meier curves for patients free from the AF recurrence in the SGLT2 inhibitors group and non-SGLT2 inhibitors group after catheter ablation for AF among entire population (A), among the patients with MetS (B), and among the patients without MetS (C). Abbreviations: AF=Atrial fibrillation; SGLT2i=Sodium-glucose cotransporter-2 inhibitor; MetS=Metabolic syndrome; HR=Hazard ratios; CI=Confidence interval. Figure 3. Sub-group analysis for AF recurrence after catheter ablation during follow-up. Abbreviations: AF=Atrial fibrillation; SGLT2i=Sodium-glucose cotransporter-2 inhibitor; BMI=Body mass index; HR=Hazard ratios; CI=Confidence interval. Figure 4. The effects of SGLT2 inhibitors on AF recurrence across the range of baseline BMI Abbreviations: AF=Atrial fibrillation; SGLT2i=Sodium-glucose cotransporter-2 inhibitor; BMI=Body mass index; HR=Hazard ratios. tables Table 1. Baseline characteristics of the study population Overall (N=377) SGLT2i (N=183) Non-SGLT2i (N=194) SMD Overall (N=769) SGLT2i (N=390) Non-SGLT2i (N=379) SMD Male sex, n, % 277 (73.5) 132 (72.1) 145 (74.7) 0.06 553 (71.9) 289 (74.1) 264 (69.7) 0.10 Age, mean±SD, year 62.4±9.4 62.1±8.8 62.8±9.9 0.07 64.5±9.7 64.6±9.4 64.3±10.0 0.03 Body mass index, mean±SD, kg/m 2 28.7±3.8 28.6±3.7 28.9±3.8 0.08 25.6±3.3 25.7±3.5 25.4±3.1 0.10 Medical history Hypertension, n, % 345 (91.5) 173 (94.5) 172 (88.7) 0.21 459 (59.7) 225 (57.7) 234 (61.7) 0.08 Coronary heart disease, n, % 73 (19.4) 43 (23.5) 30 (15.5) 0.20 166 (21.6) 109 (27.9) 57 (15.0) 0.32 Chronic heart failure, n, % 146 (38.7) 55 (30.1) 91 (46.9) 0.35 330 (42.9) 187 (47.9) 143 (37.7) 0.21 Diabetes mellitus, n, % 341 (90.5) 166 (90.7) 175 (90.2) 0.02 416 (54.1) 201 (51.5) 215 (56.7) 0.10 Stroke, n, % 34 (9.0) 20 (10.9) 14 (7.2) 0.13 109 (14.2) 64 (16.4) 45 (11.9) 0.13 Chronic kidney disease, n, % 32 (8.5) 14 (7.7) 18 (9.3) 0.06 52 (6.8) 29 (7.4) 23 (6.1) 0.06 CHA 2 DS 2 -VA Score, IQR 2.0 (1.0, 3.0) 2.0 (1.0, 3.0) 2.0 (1.0, 3.0) 0.14 1.0 (0, 1.0) 1.0 (0, 1.0) 1.0 (0, 1.0) 0.18 Characteristics of AF Persistent AF, n, % 197 (53.7) 95 (52.2) 102 (55.1) 0.06 471 (63.6) 267 (68.5) 204 (58.3) 0.21 AF duration, IQR, year 2.0 (0.5, 5.0) 2.0 (0.5, 6.0) 1.9 (0.6, 4.3) 0.15 2.0 (0.4, 5.0) 1.0 (0.3, 5.0) 3.0 (0.7, 5.4) 0.11 Laboratory indicators eGFR, mean±SD, μmol/L, mL/min/1.73m 2 86.4±25.6 88.3±29.9 84.6±20.5 0.15 85.5±21.9 83.5±19.7 87.6±23.7 0.19 Low density lipoprotein, IQR, mmol/L 2.3 (1.8, 3.0) 2.2 (1.7, 3.0) 2.4 (1.9, 3.0) 0.15 2.3 (1.7, 3.0) 2.1 (1.7, 2.9) 2.5 (1.9, 3.1) 0.29 High density lipoprotein, IQR, mmol/L 1.0 (0.9, 1.1) 1.0 (0.8, 1.1) 1.0 (0.9, 1.1) 0.03 1.2 (1.1, 1.4) 1.1 (1.0, 1.3) 1.2 (1.1, 1.4) 0.41 Total triglycerides, IQR, mmol/L 1.8 (1.3, 2.3) 1.9 (1.3, 2.5) 1.7 (1.2, 2.2) 0.20 1.2 (0.9, 1.5) 1.2 (1.0, 1.6) 1.1 (0.9, 1.4) 0.25 Ultrasound cardiogram Left atrial diameter, mean±SD, mm 42.4 ± 5.6 42.8 ± 5.7 40.6 ± 4.4 0.43 43.3 ± 6.3 43.6 ± 6.2 37.8 ± 4.7 1.05 Left ventricular end-diastolic dimension, mean±SD, mm 50.0 ± 5.7 50.0 ± 5.1 50.0 ± 6.5 <0.01 49.7 ± 6.4 50.42 ± 6.9 48.6 ± 5.4 0.30 Left ventricular ejection fraction, mean±SD, % 60.0 (52.8, 65.0) 60.0 (53.0, 65.0) 60.0 (51.0, 64.0) 0.09 60.0 (47.3, 64.0) 57.0 (44.0, 63.0) 62.0 (55.0, 65.0) 0.47 Values are mean ±SD or median (P 25 , P 75 ) or n %. Abbreviations: AF=Atrial fibrillation; SGLT2i=Sodium-glucose cotransporter-2 inhibitor; eGFR=Estimated glomerular filtration rate; SD= standard deviation; SMD= Standardized mean difference; IQR=Interquartile range. figures Figure 1. Figure 2. Figure 3. Figure 4. Information & Authors Information Version history V1 Version 1 16 June 2025 Peer review timeline Published Journal of Cardiovascular Electrophysiology Version of Record 3 Sep 2025 Published Copyright This work is licensed under a Non Exclusive No Reuse License. Collection Journal of Cardiovascular Electrophysiology Keyword clinical: catheter ablation – atrial fibrillation Authors Affiliations Yang Xu Beijing Anzhen Hospital Affiliated to Capital Medical University View all articles by this author Zixu Zhao Beijing Anzhen Hospital Affiliated to Capital Medical University View all articles by this author Hui Xu Beijing Anzhen Hospital Affiliated to Capital Medical University View all articles by this author Chao Jiang Beijing Anzhen Hospital Affiliated to Capital Medical University View all articles by this author Xiao Wang Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital View all articles by this author Zejun Yang Beijing Anzhen Hospital Affiliated to Capital Medical University View all articles by this author Wenyu Shao Beijing Anzhen Hospital Affiliated to Capital Medical University View all articles by this author Hang Guo Beijing Anzhen Hospital Affiliated to Capital Medical University View all articles by this author Liu He Beijing Anzhen Hospital Affiliated to Capital Medical University View all articles by this author Qi Guo Beijing Anzhen Hospital Affiliated to Capital Medical University View all articles by this author Caihua Sang Beijing Anzhen Hospital Affiliated to Capital Medical University View all articles by this author Deyong Long 0000-0003-4604-5346 Beijing Anzhen Hospital Affiliated to Capital Medical University View all articles by this author Xin Du Beijing Anzhen Hospital Affiliated to Capital Medical University View all articles by this author Jian zeng Dong 0000-0001-7299-7805 Beijing Anzhen Hospital Affiliated to Capital Medical University View all articles by this author Chang Sheng Ma 0000-0001-6966-6239 [email protected] Beijing Anzhen Hospital Affiliated to Capital Medical University View all articles by this author Metrics & Citations Metrics Article Usage 337 views 187 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Yang Xu, Zixu Zhao, Hui Xu, et al. 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