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Volume 14
Issue 22
10.3390/jcm14228003
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

Targeting Atrial Fibrillation in HFpEF: Comparative Effectiveness of Rhythm Control Strategies and Modulatory Effects of SGLT2 Inhibitors

by
Marius-Dragoș Mihăilă
1,
Ioan-Alexandru Minciună
1,2,*,
Bogdan Caloian
1,2,
Florina Iulia Frîngu
1,2,
Samuel Bogdan Todor
3,
Andrei Iulian Aleman
2 and
Dana Pop
1,2
1
4th Department of Internal Medicine, Department of Cardiology Rehabilitation, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
2
Department of Cardiology Rehabilitation, Clinical Rehabilitation Hospital, 400437 Cluj-Napoca, Romania
3
Department of Haematology, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 550169 Sibiu, Romania
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2025, 14(22), 8003; https://doi.org/10.3390/jcm14228003
Submission received: 22 October 2025 / Revised: 5 November 2025 / Accepted: 10 November 2025 / Published: 11 November 2025
(This article belongs to the Special Issue Clinical Advances in the Diagnosis and Treatment of Cardiac Arrhythmias)
Versions Notes

Abstract

Background: Atrial fibrillation (AF) is a common comorbidity in heart failure with preserved ejection fraction (HFpEF), yet the optimal rhythm control strategies and the emerging role of sodium–glucose cotransporter-2 inhibitors (SGLT2i) in maintaining sinus rhythm remain unclear. Methods: We conducted a single-centre, retrospective study of 120 consecutive HFpEF patients with paroxysmal or persistent AF, treated by electrical cardioversion, radiofrequency ablation (RFA), or cryoablation. The primary outcome was AF recurrence, with secondary outcomes including time to recurrence and the impact of SGLT2i on AF recurrence. Results: Both cryoablation (HR = 0.226, 95% CI: 0.089–0.573, p = 0.002) and RFA (HR = 0.293, 95% CI: 0.131–0.654, p = 0.003) were associated with lower AF recurrence rates and longer arrhythmia-free survival compared to electrical cardioversion. SGLT2i therapy was independently associated with fewer recurrences (HR = 0.421, 95% CI: 0.266–0.786, p = 0.007) and a 12-week extension of AF-free time. Conclusions: In HFpEF with AF, prioritising catheter ablation over cardioversion and combining rhythm control with SGLT2i improves rhythm durability.
Keywords: heart failure with preserved ejection fraction; atrial fibrillation; catheter ablation; electrical cardioversion; sodium–glucose cotransporter 2 inhibitors heart failure with preserved ejection fraction; atrial fibrillation; catheter ablation; electrical cardioversion; sodium–glucose cotransporter 2 inhibitors

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MDPI and ACS Style

Mihăilă, M.-D.; Minciună, I.-A.; Caloian, B.; Frîngu, F.I.; Todor, S.B.; Aleman, A.I.; Pop, D. Targeting Atrial Fibrillation in HFpEF: Comparative Effectiveness of Rhythm Control Strategies and Modulatory Effects of SGLT2 Inhibitors. J. Clin. Med. 2025, 14, 8003. https://doi.org/10.3390/jcm14228003

AMA Style

Mihăilă M-D, Minciună I-A, Caloian B, Frîngu FI, Todor SB, Aleman AI, Pop D. Targeting Atrial Fibrillation in HFpEF: Comparative Effectiveness of Rhythm Control Strategies and Modulatory Effects of SGLT2 Inhibitors. Journal of Clinical Medicine. 2025; 14(22):8003. https://doi.org/10.3390/jcm14228003

Chicago/Turabian Style

Mihăilă, Marius-Dragoș, Ioan-Alexandru Minciună, Bogdan Caloian, Florina Iulia Frîngu, Samuel Bogdan Todor, Andrei Iulian Aleman, and Dana Pop. 2025. "Targeting Atrial Fibrillation in HFpEF: Comparative Effectiveness of Rhythm Control Strategies and Modulatory Effects of SGLT2 Inhibitors" Journal of Clinical Medicine 14, no. 22: 8003. https://doi.org/10.3390/jcm14228003

APA Style

Mihăilă, M.-D., Minciună, I.-A., Caloian, B., Frîngu, F. I., Todor, S. B., Aleman, A. I., & Pop, D. (2025). Targeting Atrial Fibrillation in HFpEF: Comparative Effectiveness of Rhythm Control Strategies and Modulatory Effects of SGLT2 Inhibitors. Journal of Clinical Medicine, 14(22), 8003. https://doi.org/10.3390/jcm14228003

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