SGLT2 inhibitors and risk of atrial fibrillation recurrence after catheter ablation: A systematic review and meta-analysis of observational studies

Background Sodium–glucose cotransporter 2 inhibitors (SGLT2i) exhibit potential antiarrhythmic effects, but their influence on atrial fibrillation (AF) recurrence after catheter ablation (CA) remains unclear. Objective This study aimed to assess the association between SGLT2i therapy and the risk of recurrent AF after CA through an updated systematic review and meta-analysis of observational studies. Methods A systematic search of PubMed and Scopus (inception to July 2025) identified eligible observational studies. Pooled hazard ratios for AF recurrence after CA were estimated using Mantel–Haenszel random-effects models, with heterogeneity assessed by I2. The protocol was registered in PROSPERO (CRD42024620765). Results 6 observational studies were included, comprising 2165 patients (mean age 65.2 years; 34.9% female), of whom 663 received SGLT2i therapy and 1502 did not. The average follow-up duration was 19.9 months. Pooled analysis showed a significantly reduced risk of AF recurrence in patients treated with SGLT2i compared with those not receiving SGLT2i (hazard ratio 0.49; 95% confidence interval 0.36–0.67; P < .0001; I2 = 68.3%). Subgroup analyses confirmed consistent benefits in both diabetic and nondiabetic patients and with the use of radiofrequency or cryoablation. A multivariable meta-regression model including age, female sex, diabetes mellitus, and follow-up duration accounted for a significant portion of the observed heterogeneity (R2 = 58.1%; P = .01). Conclusion SGLT2i therapy is associated with a significantly lower risk of AF recurrence after CA, independent of diabetic status. Further randomized controlled trials are warranted to validate these findings and explore the mechanisms underlying this association.