Dapagliflozin does not prevent AF recurrence in postablation patients with no SGLT2i indication
AHA 2025 – Short-term dapagliflozin treatment did not reduce AF recurrence 3 months after catheter ablation in patients with persistent AF and with no indication for SGLT2 inhibitor therapy, compared with usual care.
This summary is based on the presentation of Zixu Zhao, MD (Beijing, China) at the AHA Scientific Sessions 2025 - Dapagliflozin to Reduce Atrial Fibrillation Burden After Catheter Ablation for Atrial Fibrillation in Patients Without Diabetes or Heart Failure: The DARE-AF Randomized Clinical Trial.
Introduction and methods
Previous observational studies have indicated that SGLT2 inhibitor treatment could lower the risk of AF recurrence after catheter ablation in AF patients with concomitant diabetes, HF, or CKD. However, there are no randomized trial data on the effect of SGLT2 inhibitors on the prevention of early AF recurrence following catheter ablation in patients with no Class I indication for this medication.
The DARE-AF (Dapagliflozin on Recurrence After Catheter Ablation for Atrial Fibrillation) trial was an open-label parallel-group RCT conducted at the Beijing Anzhen Hospital in Beijing, China. A total of 200 patients with persistent AF who were scheduled to undergo first-time catheter ablation and had no Class I indication for dapagliflozin (diabetes, HF, or CKD) were randomized to dapagliflozin 10 mg once daily for 3 months after the ablation, in addition to usual care, or usual care only.
The primary endpoint was AF burden at 3 months after ablation, as assessed with a 7-day single-lead ECG patch. Secondary endpoints were AF recurrence, echocardiographic changes of left atrial structure, and quality of life as assessed with the AF Effect on Quality-of-Life Questionnaire (AFEQT) at 3 months.
Main results
- In the intention-to-treat analysis, there was no difference in the occurrence of the primary endpoint of AF burden 3 months postablation between patients treated with dapagliflozin and those in the control group (mean ± SD: 7.5 ± 23.6% vs. 8.1 ± 25.5%; P=0.48).
- The cumulative incidence of AF recurrence at 3 months was 29.6% in the dapagliflozin group and 28.0% in the control group (HR: 1.11; 95%CI: 0.66–1.86; P=0.70).
- At 3 months, there were also no differences in changes in left atrial anterior–posterior diameter (mean difference: –0.17; 95%CI: –1.40 to 1.06; P=0.87) and AFEQT score (mean difference: –1.36; 95%CI: –7.80 to 5.08; P=0.68) between the 2 groups.
- The rate of serious adverse events was similar in the dapagliflozin and control groups (11.0% vs. 10.0%). During follow-up, 2 patients randomized to dapagliflozin died (due to MI or cardiac arrest), which was deemed not to be related to the study drug.
Conclusion
In this single-center open-label RCT, 3-month treatment with dapagliflozin did not reduce early AF recurrence after catheter ablation in patients with persistent AF and with no established indication for SGLT2 inhibitor therapy, compared with usual care only. Dr. Zhao concluded that the “results suggest that the potential antiarrhythmic effects of SGLT2 inhibitors may stem from improvements in underlying cardiometabolic conditions rather than a direct antiarrhythmic action.”
- Our reporting is based on the information provided at the AHA Scientific Sessions 2025 -