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

Abstract

Background Sodium-glucose cotransporter 2 (SGLT-2) inhibitors had a significant improvement in strain parameters and lower atrial fibrillation (AF) recurrence. The aim of this study is to determine the impact of SGLT-2 inhibitors on left atrial (LA) mechanical functions and recurrence in the early period after Cryoballoon ablation (CBA) for paroxysmal AF in non-diabetic patients. Methods Consecutive eighty non-diabetic preserved ejection fraction patients with paroxysmal AF underwent CBA 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. Recurrence was evaluated through holter-ECG monitoring performed at regular intervals. Results In the group of patients using SGLT-2 inhibitors, a significant decrease in LA diameter and indexed LA volume values (40.9 +/- 4.2 mm vs. 39.6 +/- 3.8 mm, p = 0.001 and 32.6 +/- 8.2 ml/m2 vs. 30.8 +/- 7.7 ml/m2, p = 0.006), and a significant improvement in LA conduit strain value were observed (-14.4 +/- 7.5% vs. -18.5 +/- 6.9%, p < 0.001). Additionally, as the indicators of left atrial compliance, LA reservoir strain and LA conduit strain showed a significantly improvement in the group using SGLT-2 inhibitors (p = 0.025, p delta = 0.045, respectively) and non-recurrence group (p < 0.001). Conclusion In non-diabetic paroxysmal AF patients using dapagliflozin significant improvement in mechanical functions can be achieved even in the early period after CBA. In addition, 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.