Impact of Sodium-glucose co-transporter 2 inhibitors on Atrial Fibrillation Recurrence Post- catheter ablation among patients with type 2 diabetes mellitus: A systematic review and meta-analysis

Background: Atrial fibrillation (AF) is the most common cause of arrhythmia-induced cardiomyopathy. Effective management strategies include medical therapy for rate and rhythm control, catheter ablation (CA), and goal directed medical therapy. Sodium-glucose co-transporter 2 inhibitors (SGLT2i), a novel class of anti-diabetic drugs, have shown a promising impact in reducing cardiovascular events in diabetic and non-diabetic heart failure (HF) patients. It is unclear what impact SGLT2i use may have on AF recurrence following catheter ablation. Aim: To evaluate the effects of SGLT2i on preventing AF recurrence following CA and impact on other cardiovascular outcomes. Methods: and results We performed a comprehensive literature search through multiple search engines (Pubmed, Scopus, Web of Science, and Cochrane) to include eligible studies using the appropriate keywords until 10th April 2024. Our search yielded nine eligible studies with 16,857 patients. Our analysis reveals a significant reduction in AF recurrence after catheter ablation among patients receiving SGLT2i compared to non-SGLT2i medications (RR = 0.72, 95% CI [0.67, 0.78], P < 0.00001). Additionally, SGLT2i therapy was associated with decreased all-cause hospitalizations and reduced risk of ischemic stroke. However, no significant difference in all-cause mortality was observed between SGLT2i and non-SGLT2i groups. Conclusion: Our study found that SGLT2 inhibitors significantly reduced AF recurrence post-CA in diabetic patients. Moreover, SGLT2i use was associated with lowered hospitalization and ischemic stroke risk. Though no significant difference in mortality was noted, the decrease in hospitalization suggests a possible favorable effect on cardiovascular events.