Abstract 4369642: Efficacy of Sodium-Glucose Transport Protein 2 Inhibitors in Prevention Atrial Fibrillation post - Coronary Artery Bypass Graft Surgery: A Systematic Review and Meta-Analysis

Abstract

Introduction: Atrial fibrillation(AF) following coronary artery bypass graft is a prevalent complication often occurring 2-4 days postoperatively, characterised by brief asymptomatic episodes. It increases morbidity, hospital stay, risk of stroke and mortality. The pathophysiology involves triggers that act on a susceptible remodelled-atrium. Risk factors include age, heart failure, hypertension and atrial enlargement. Emerging evidence indicates Sodium-Glucose Transport Protein 2 Inhibitors (SGLT2i) like empagliflozin may prevent post-Coronary Artery Bypass Graft Surgery (CABGs) associated AF by reducing sympathetic outflow, atrial remodelling and inflammation. Considering these mechanisms and existing data we have developed this study to assess the potential of SGLT2i in preventing postoperative atrial fibrillation in patients undergoing coronary artery bypass graft. Methodology: The review conducted follows the PRISMA guidelines and major medical databases, which include PUBMED, Google Scholar and Science-Direct, were extensively searched using a comprehensive search term to identify and retrieve available articles. The articles that included the assessment of the efficacy of SGLT2i in the prevention of AF post-CABGs were considered for the final analysis. The data was analysed using the Meta, Metadata and the Metafor packages of R Studio. The Odds Ratio of occurrence of Atrial Fibrillation was assessed as the primary outcome. The Mantel-Haenszel method (Common effect model) and the Inverse variance method (Random effects model) were utilized to analyse the odds ratio. The I^2 test was used to assess the heterogeneity. Results: The review included a total of 4 articles with a standard control and SGLT2i therapy to prevent the occurrence of AF in post-CABGs patients. A total of 6011 patients out of which 2002 patients received SGLT2i therapy and 3998 patients belonged to the control groups. The occurrence of AF was significantly lower in the SGLT2i in comparison to the Control Groups (OR = 0.74, 95% CI [0.64; 0.85], p = 0.2901]. Conclusion: This review highlights the potential of SGLT2 inhibitors in reducing the risk of atrial fibrillation following coronary artery bypass graft surgery. Compared to standard care, patients receiving SGLT2i therapy experienced a significantly lower incidence of postoperative AF. These findings support the growing evidence for the cardioprotective effects of SGLT2 inhibitors, reinforcing their role in post-surgical cardiac care.