The impact of dapagliflozin on left atrial functions in non-diabetic atrial fibrillation patients in the early post-cryoablation period

Sodium-glucose cotransporter 2 (SGLT-2) inhibitors are oral antidiabetic drugs that act primarily by increasing the urinary elimination of glucose. In addition, SGLT2i have multiple pleiotropic effects of glucose independent and direct cardiac protection that may improve left atrial (LA) remodeling. Previous studies have shown that patients with type 2 diabetes who used SGLT-2 inhibitors had a significant improvement in echocardiographic LA strain parameters and lower AF recurrence compared to patients who did not use SGLT-2. However, there is no data on the impact of SGLT-2 inhibitors on echocardiographic parameters in non-diabetic patients. The aim of this study is to determine the impact of SGLT-2 inhibitors on LA mechanical functions in the early period after CB-2 ablation for paroxysmal atrial fibrillation (PAF) in non-diabetic patients.

Consecutive eighty non-diabetic preserved EF patients (mean age: 59±11.7 years; %56 men) with PAF underwent CB-2 and were prospectively analyzed. All echocardiographic measurements were obtained during sinus rhythm. After the procedure, dapagliflozin 10mg daily was initiated in 40 out of 80 patients. The LA dimensions, the LA reservoir strain (LASr), the LA atrial contractile strain (LASct), the LA conduit strain (LAScd) and left ventricular diastolic function parameters were evaluated by Doppler echocardiography before and 3 months after the procedure in all patients and compared in groups using and not using dapagliflozin.

In the patients not using SGLT-2 inhibitors, a significant improvement was observed in LAsr, LAsct, and LV endo average strain (33.9±9.2% vs 37.8±8% p<0.001; -13.7±5.4% vs -16.3±6.4%, p=0.015 and -21.6±2.8% vs -23.8±2.6%, p=0.001). However, no significant changes were detected in other echocardiographic parameters. In the group of patients using SGLT-2 inhibitors, a significant decrease in LA diameter and LAVI values was noted (40.9±4.2mm vs 39.6±3.8mm, p=0.001 and 32.6±8.2ml/m2 vs 30.8±7.7ml/m2, p=0.006) and a significant improvement in LAscd value was observed (-14.4±7.5% vs -18.5±6.9%, p<0.001), which differed from the patient group not using SGLT-2 inhibitors. Additionally, it was detected that the indicator of left atrial compliance, LAsr and LAscd, showed a significantly greater improvement in the group using SGLT-2 inhibitors compared to the group not using SGLT-2 inhibitors (LAsrdelta=0.025, LAscd delta=0.045).

In non-diabetic PAF patients using dapagliflozin significant improvement in mechanical functions can be achieved even in the early period after CB-2 ablation. In addition, as our study points out strain parameters, patients using SGLT-2 inhibitors, a significant improvement in left atrial compliance is observed compared to those who do not use. Further studies are needed to evaluate its potential contribution on AF freedom.