Association of SGLT2 inhibitors with post-ablation atrial fibrillation recurrence in individuals with heart failure or type 2 diabetes mellitus: a systematic review and meta-analysis
Abstract
Background: The impact of sodium-glucose cotransporter-2 inhibitors (SGLT2i) on post-ablation atrial fibrillation (AF) recurrence is still unclear. Accordingly, we investigated whether exposure to SGLT2i reduces post-ablation AF recurrence among individuals with heart failure (HF) or type 2 diabetes mellitus (T2DM).
Methods: We carried out a structured search of PubMed, Embase, and the Cochrane Library from database launch through August 17, 2025. Pooled analyses were generated with RevMan 5.4 and Stata 18.
Results: 11 studies were included, comprising 2 randomized controlled trials (RCTs) and 9 retrospective cohort studies, with a total of 7,664 individuals. Among them, 3,390 received SGLT2i therapy, and 4,274 received non-SGLT2i therapy. Compared with the non-SGLT2i, SGLT2i was linked to decreased post-ablation AF recurrence (RR: 0.61, 95% CI: 0.52-0.71, p p p p = 0.010), fewer rehospitalization (RR: 0.79, 95% CI: 0.72-0.88, p p = 0.009).
Conclusions: Use of SGLT2i was linked to reduced post-ablation AF recurrence, and this association was consistent in AF individuals with T2DM as well as those with HF. Additionally, SGLT2i therapy correlated with reduced risks of all-cause mortality, rehospitalization, and thromboembolic events.
Systematic review registration: identifier CRD420251125971.
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 7,664 participants or records.
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