The impact of dapagliflozin on left atrial functions and recurrence in non-diabetic 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. Previous studies have shown that patients with type 2 diabetes who used SGLT-2 inhibitors had a significant improvement in strain parameters and lower AF recurrence[1,2]. The aim of this study is to determine the impact of SGLT-2 inhibitors on LA mechanical functions and recurrence in the early period after CB-2 ablation for paroxysmal atrial fibrillation (PAF) in non-diabetic patients.

Consecutive eighty non-diabetic preserved EF patients with PAF underwent CB-2 were analyzed. After the procedure, dapagliflozin was initiated in 40 out of 80 patients. LA strain parameters were evaluated before and 3 months after the procedure compared in groups using and not using dapagliflozin(figure1). Recurrence was evaluated through holter-ECG monitoring performed at regular intervals.

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 (LAsrdelta=0.025, LAscd delta=0.045) and non-recurrence group(figure2). Although not reaching statistical significance, recurrence was observed less frequently in patients using SGLT-2 inhibitors.

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. Further studies with larger population are needed to prove its potential contribution on AF freedom after AF ablation.Figure 1Figure 2