Sodium-Glucose Cotransporter-2 Inhibitor Use and Lower Left Atrial Epicardial Adipose Tissue Volume Across Metabolic Phenotypes in Atrial Fibrillation.

BACKGROUND

Epicardial adipose tissue (EAT) is implicated in atrial fibrillation (AF), yet pharmacologic strategies to modify EAT remain incompletely defined.

OBJECTIVE

We evaluated whether sodium-glucose cotransporter-2 inhibitor (SGLT2i) use is associated with lower left atrial EAT volume (LA-EATV) in AF ablation candidates and whether this association varies across metabolic phenotypes.

METHODS

In this single-center retrospective study, consecutive AF ablation candidates with analyzable preprocedural contrast-enhanced computed tomography (CECT) were included. Two prespecified multivariable linear regression models (continuous and binary covariates) were constructed, and 1:2 propensity score matching (PSM) was performed. Interaction analyses across metabolic phenotypes were also performed.

RESULTS

Of 1,321 candidates, 1,133 had analyzable CECT data. In both multivariable models, SGLT2i use was associated with lower log-transformed LA-EATV (β = -0.274, p = 0.01 and β = -0.296, p = 0.009, respectively), corresponding to approximately 25% lower LA-EATV. The inverse association was also observed in the propensity score-matched cohort (β = -0.314, 95% confidence interval -0.585 to -0.044; p = 0.023). Significant interactions were observed for triglyceride (TG) level and body mass index (BMI). The association was stronger in patients with TG ≥175 mg/dL and attenuated in those with BMI ≥25 kg/m2. The strongest phenotype-stratified association was observed in patients with hypertriglyceridemia but without obesity (p = 0.01).

CONCLUSION

SGLT2i use was associated with lower LA-EATV in patients with AF after multivariable adjustment. Exploratory findings suggested that the strength of this association may vary according to metabolic phenotype, but these hypothesis-generating observations require confirmation in larger studies.