Impact of Sodium‐Glucose Cotransporter 2 Inhibitor on Recurrence After Catheter Ablation for Atrial Fibrillation in Patients With or Without Metabolic Syndrome

ABSTRACT Aims The impact of sodium‐glucose cotransporter‐2 inhibitors (SGLT2i) on atrial fibrillation (AF) recurrence after catheter ablation is still inconclusive. Besides, their efficacy on AF recurrence stratified by metabolic syndrome (MetS) status remains unknown. Methods Patients with AF undergoing initial catheter ablation between January 2017 and December 2023 from the China‐AF Registry were included. Patients were 1:1 propensity score‐matched by SGLT2i use at discharge and stratified by baseline MetS status. The main outcome was the AF recurrence after a 3‐month blanking period. Results After propensity score matching, 573 patients in the SGLT2i group and 573 in the non‐SGLT2i group were included in the study. During the 20.5 ± 13.7 months follow‐ups, AF recurrence occurred in 100 patients (17.5%) in the SGLT2i group and 168 patients (29.3%) in the non‐SGLT2i group. SGLT2i was associated with lower AF recurrence (17.5% vs. 29.3%; HR 0.59, 95% CI: 0.46–0.75, p < 0.001), with consistent benefits in MetS (HR 0.61, 95% CI: 0.39–0.75, p = 0.03) and non‐MetS subgroups (HR 0.58, 95% CI: 0.43–0.78, p < 0.001, P interaction = 0.841). The effect of SGLT2i on the AF recurrence also remained consistent across the body mass index (BMI) spectrum ( P interaction = 0.740). Conclusion SGLT2i was associated with a lower risk of AF recurrence after catheter ablation independently of MetS status or BMI spectrum.