Impact of sodium-glucose cotransporter 2 inhibitor on recurrence and cardiovascular outcomes after catheter ablation for atrial fibrillation in patients with chronic kidney disease.

Background: The effect of sodium-glucose cotransporter 2 inhibitor (SGLT2i) on atrial fibrillation (AF) recurrence after catheter ablation in patients with chronic kidney disease (CKD) remains uncertain.

Objective: The purpose of this study was to investigate whether SGLT2i treatment is associated with a reduced risk of AF recurrence after catheter ablation in patients with CKD.

Methods: From the prospective Chinese Atrial Fibrillation Registry, we identified 628 patients with AF and CKD undergoing initial catheter ablation from January 2019 to December 2023. Patients were stratified into the SGLT2i group (n = 119) and the non-SGLT2i group (n = 509) on the basis of discharge prescriptions. Propensity score-derived overlap weighting was used to balance baseline characteristics. The primary outcome was AF recurrence after the 3-month blanking period.

Results: With a mean follow-up duration of 13.1 ± 5.3 months, patients in the SGLT2i group had a lower rate of AF recurrence than did those in the non-SGLT2i group after overlap weighting adjustment (21.8% [26 of 119] vs 31.2% [159 of 509]; adjusted hazard ratio [HR] 0.56; 95% confidence interval [CI] 0.32-0.98; P = .044). Additionally, the SGLT2i group demonstrated a substantially lower rate of the composite outcome (cardiovascular mortality, cardiovascular hospitalization, or thrombotic events; adjusted HR 0.38; 95% CI 0.20-0.73; P = .004), with the most substantial reduction observed for cardiovascular hospitalization (adjusted HR 0.33; 95% CI 0.16-0.68; P = .002).

Conclusion: SGLT2i treatment was associated with reduced risks of AF recurrence and the composite outcome (cardiovascular mortality, cardiovascular hospitalization, or thrombotic events) in patients with CKD undergoing catheter ablation for AF.