New Findings Question SGLT2 Inhibitors for Post-Ablation AF Recurrence
In a development that surprises many in the cardiology community, the DARE-HF trial examined whether the SGLT2 inhibitor dapagliflozin could reduce the burden of atrial fibrillation (AF) after catheter ablation. Conducted in patients who recently underwent ablation for AF, the study aimed to determine if adding dapagliflozin to standard post-procedure care would lower AF recurrence or burden, improve quality of life, and enhance safety in this high-risk population.
Study Design and Patient Population
The trial enrolled participants with a history of AF who had undergone successful catheter ablation. Researchers randomized patients to receive dapagliflozin or a placebo, with follow-up extending for several months. The primary endpoints focused on AF burden, quantified by continuous rhythm monitoring, and secondary endpoints included cardiovascular outcomes, hospitalization rates, and patient-reported quality of life measures.
Results: No Reduction in AF Burden
Across the primary analyses, dapagliflozin did not demonstrate a meaningful reduction in AF burden compared with placebo. The rate of AF recurrence, times spent in AF, and overall rhythm control metrics were similar between the two groups. In addition, secondary outcomes such as hospitalization for cardiovascular causes and major adverse cardiovascular events did not show a statistically significant difference attributable to dapagliflozin therapy.
Safety and Tolerability
Adverse events were monitored closely, given concerns about volume status and renal function with SGLT2 inhibitors. The safety profile of dapagliflozin in the post-ablation setting appeared comparable to placebo, with no unexpected safety signals emerging during the trial period. Nevertheless, the lack of efficacy in reducing AF burden means that any potential safety advantage would be unlikely to justify routine post-ablation use in this context.
Clinical Implications
The negative result from DARE-HF carries important implications for clinicians treating AF patients after ablation. While SGLT2 inhibitors have shown cardiovascular benefits in other contexts, this trial suggests that their role in preventing AF recurrence after ablation is limited. Physicians should continue to base post-ablation management decisions on rhythm control strategies, antiarrhythmic drugs, and close rhythm monitoring rather than relying on SGLT2 inhibitors to reduce AF burden.
What’s Next for Research?
Researchers may explore whether specific subgroups could benefit from SGLT2 inhibition or whether combination therapies might offer incremental improvements. Additionally, longer follow-up, different dosing strategies, or integration with advanced ablation techniques could be areas of future investigation. Until such data emerge, dapagliflozin should be considered independent of AF burden reduction goals after catheter ablation.
Bottom Line for Patients and Providers
For patients who have undergone AF ablation hoping to avoid recurrent episodes, dapagliflozin does not appear to offer a proven advantage in reducing AF burden. The findings reinforce the need for comprehensive post-ablation care anchored in rhythm surveillance and conventional therapies, with SGLT2 inhibitors viewed through the lens of other cardiovascular indications rather than as a primary strategy for AF recurrence prevention.
