Article Impact Level: HIGH Data Quality: STRONG Summary of JACC: Clinical Electrophysiology, 8(11), 1393–1404. https://doi.org/10.1016/j.jacep.2022.08.004 Dr. Hideyuki Kishima et al
Points
- Tofogliflozin, an SGLT2 inhibitor, was found to have a reduced risk of relapse than anagliptin in a trial of 80 people with type 2 diabetes who had their atrial fibrillation ablation
- SGLT2 inhibitor Tofogliflozin may be helpful as a supplement to catheter ablation therapy for atrial fibrillation.
- There is widespread agreement that type 2 diabetes considerably raises the chance of developing atrial fibrillation.
Summary
The trial aimed to find the answer of sodium-glucose cotransporter 2 inhibitors on Atrial Fibrillation after catheter Ablation. This prospective, randomized controlled research compared the repressive impact of SGLT2i against dipeptidyl peptidase-4 inhibitors on Atrial Fibrillation relapse following catheter ablation. At testing, 80 Atrial Fibrillation patients who also had diabetes mellitus were randomized to receive either tofogliflozin (20 mg/d) or anagliptin (200 mg/d), with the groups being separated based on left atrial width and Atrial Fibrillation type whether it was paroxysmal or nonparoxysmal. The main result was the return of Atrial Fibrillation a year after Catheter Ablation.
70 participants were randomly assigned. Persistent Atrial Fibrillation was seen in 24 patients, and the anagliptin group had a greater Atrial Fibrillation return ratio than the tofogliflozin class. The relapse participants had a greater likelihood of nonparoxysmal Atrial fibrillation, raised B-type natriuretic peptide, increased urinary albumin-creatinine ratio, significant reduction of SGLT2i usages, bigger left atrial diameter, raised E wave, reduced left ventricular ejection fraction, and reduced rate of cryoballoon pulmonary vein isolation especially in comparison to the nonrecurrence group, according to univariate analysis.
According to the researchers, tofogliflozin greatly decreased the occurrence of Atrial Fibrillation recurrence following catheter ablation in individuals with insulin resistance compared to anagliptin.
Individuals with type-2 diabetes who used SGLT2i were demonstrated to experience fewer heart problems, hospitalization, and sudden cardiac death. SGLT2i have several pleiotropic effects of glucose-independent and direct cardiac protection that may enhance atrial remodeling and improve the urine excretion of sugar. According to certain research, SGLT2i may lessen atrial tachyarrhythmia.
Furthermore, to manage Atrial Fibrillation relapse following ablation, it’s critical to manage Atrial Fibrillation’s possible risks, including insulin resistance, adiposity, and high blood pressure. In this study, the investigators examined the results of tofogliflozin against anagliptin ablation of Atrial Fibrillation in individuals with type 2 diabetes mellitus. Compared to anagliptin, tofogliflozin usage was linked to a decreased occurrence of subsequent Atrial Fibrillation after ablation. The research was limited and more blinded, controlled studies are required to thoroughly assess the impact of SGLT2i on Atrial Fibrillation in diabetic individuals.
Link to the article: https://www.jacc.org/doi/10.1016/j.jacep.2022.08.004
References Kishima, H., Mine, T., Fukuhara, E., Kitagaki, R., Asakura, M., & Ishihara, M. (2022). Efficacy of sodium-glucose cotransporter 2 inhibitors on outcomes after catheter ablation for atrial fibrillation. JACC: Clinical Electrophysiology, 8(11), 1393–1404. https://doi.org/10.1016/j.jacep.2022.08.004
