Effect of SGLT2 Inhibitors on Atrial Electromechanical Delay in Patients with Type 2 Diabetes

Sodium-glucose cotransporter-2 (SGLT2) inhibitors have been associated with lower atrial fibrillation (AF) incidence in diabetes mellitus (DM). Atrial electromechanical delay (AEMD) is an electrophysiological marker related to AF development. This study evaluated AEMD changes in type 2 DM patients treated with an SGLT2 inhibitor (dapagliflozin or empagliflozin). Baseline and 4-month follow-up data of 50 patients with type 2 diabetes who initiated SGLT2 inhibitor therapy were retrospectively obtained from medical records and analyzed. AEMD was measured using echocardiography and tissue Doppler. Inter-AEMD and intra-AEMD intervals were calculated. Left atrial volume (LAVOL) significantly decreased (45.23 ± 9.27 vs 42.21 ± 9.16; P < .001), while left intra-AEMD (19.58 ± 7.53 vs 16.76 ± 7.53; P <.001), right intra-AEMD (14.42 ± 5.81 vs 12.46 ± 8.05; P = .016), and inter-AEMD (34 ± 9.41 vs 29.22 ± 9.44; P < .001) were significantly reduced. Inter-AEMD change correlated with LAVOL, E/E′ ratio, body mass index, and mean blood pressure changes (all P <.05). In diabetic patients treated with SGLT2 inhibitors, AEMD reduction was observed after 4 months, with favorable metabolic and hemodynamic effects. These findings suggest that SGLT2 inhibitors may protect against AF by improving atrial electromechanical function.