Arrhythmias & electrophysiology
Sodium–Glucose Cotransporter-2 Inhibitor Use and Lower Left Atrial Epicardial Adipose Tissue Volume Across Metabolic Phenotypes in Atrial Fibrillation
Authors' 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.
Study context
- Population
- Atrial fibrillation (AF) ablation candidates with analyzable preprocedural contrast-enhanced computed tomographyhad analyzable contrast-enhanced computed tomography data, of 1321 candidates
- Participants
- 1,133 candidates
- Exposure
- Sodium-glucose cotransporter-2 inhibitor (SGLT2i) use is associated with lower left atrial epicardial adipose tissue (EAT) volume (left atrial EAT volume (LA-EATV))
- Outcome
- Log-transformed LA-EATV (multivariable models)
Methodological detailsconsecutive, 2 prespecified multivariable linear regression models (continuous and binary covariates), 1:2 propensity score matching, interaction analyses across metabolic phenotypes
- Consecutive
- 2 prespecified multivariable linear regression models (continuous and binary covariates)
- 1:2 propensity score matching
- Interaction analyses across metabolic phenotypes
Main finding
As reported in the abstract
β
−0.274
P = 0.01
first multivariable model; lower LA-EATV with SGLT2i use
β
−0.296
P = 0.009
second multivariable model; lower LA-EATV with SGLT2i use
- Corresponding to approximately lower LA-EATV
- 25%
Observational data: associations, not effects.
Further findings
| Outcome | β (95% CI) | P value |
|---|---|---|
| Log-transformed LA-EATV (propensity score-matched cohort)Inverse association · propensity score-matched | −0.314 (−0.585 to −0.044) | P = 0.023 |
Interaction across metabolic phenotypes
- Strongest phenotype-stratified association in patients with hypertriglyceridemia but without obesity
- P = 0.01
- Significant interactions for triglyceride level and body mass index
- Association stronger in patients with triglyceride ≥175 mg/dL and attenuated in those with body mass index ≥25 kg/m²
- Exploratory
Original publication
Sodium–Glucose Cotransporter-2 Inhibitor Use and Lower Left Atrial Epicardial Adipose Tissue Volume Across Metabolic Phenotypes in Atrial Fibrillation. Heart Rhythm. Published 17 September 2026. doi:10.
Summarised from the published abstract; every number is checked against it