Sodium-glucose cotransporter 2 inhibitors not only suppress recurrence after atrial fibrillation ablation but also cause atrial reverse remodeling

Abstract

Background: Sodium-glucose cotransporter 2 (SGLT2) inhibitors have shown fewer heart failure (HF) hospitalization and cardiovascular death in patients with type-2 diabetes mellitus (DM). Atrial fibrillation (AF) is associated with both HF and DM, and we reported SGLT2 suppressed AF recurrence after catheter ablation (CA) than dipeptidyl peptidase-4 (DPP4) inhibitor. Purpose: We evaluated whether SGLT2 itself induces atrial reverse remodeling. Methods: This is a sub-analysis of a prospective randomized controlled open-label clinical study for comparing the suppressive effect of SGLT2 inhibitor with DPP4 inhibitor on AF recurrence after CA. Eighty AF patients with type-2 DM were randomized to Tofogliflozin group or Anagliptin group with a computer-generated random sequence, which was stratified by left atrial diameter and AF type at screening. Primary outcome is AF recurrence at 12 months after CA, and secondary outcomes include the echocardiographic findings. Results: 70 patients (70.3±8.1 years, 58 male, 30 paroxysmal AF, 38 Tofogliflozin) were analyzed. Recurrent AF was detected in 24 patients (34.3%), and the AF recurrence ratio was higher in the Anagliptin group than the Tofogliflozin group. In 46 patients without AF recurrence (17 Anagliptin, 29 Tofogliflozin), LAVI has shrunk in 12 months compared to the baseline (42.8±11.9 to 36.6±11.2ml/m2) and the reduction of LAVI was larger in Tofogliflozin group than Anagliptin group (-8.6±2.0ml/m2 vs. -2.0±2.6ml/m2, P=0.0471). Conclusion: Tofogliflozin not only suppressed AF recurrence after CA but also caused atrial reverse remodeling than Anagliptin in type-2 DM patients.