Overview: DARE-AF Trial Questions SGLT2 Inhibition After Ablation
The latest findings from the DARE-AF trial suggest that dapagliflozin, an SGLT2 inhibitor, does not reduce the burden of atrial fibrillation (AF) after catheter ablation. Conducted in a diverse patient population, the study aimed to determine whether adding dapagliflozin to standard post-ablation care could lower AF recurrence and improve clinical outcomes.
Study Design and Population
DARE-AF was a randomized, controlled trial enrolling adults with atrial fibrillation who were undergoing catheter ablation. Participants were assigned to receive dapagliflozin or a placebo in addition to guideline-directed post-ablation management. The primary endpoint focused on AF recurrence or clinically relevant arrhythmia at 12 months, while secondary endpoints included hospitalizations for heart failure, quality of life measures, and safety signals related to SGLT2 inhibition.
Key Findings: No Reduction in AF Burden
Results showed no statistically significant difference in AF recurrence between the dapagliflozin group and placebo. The primary outcome, atrial tachyarrhythmia burden over the first year after ablation, remained similar across both arms. These findings indicate that, despite known benefits of SGLT2 inhibitors in heart failure and metabolic health, dapagliflozin did not translate into a lower AF burden when added to post-ablation care.
Secondary Outcomes and Safety
Secondary analyses revealed no meaningful improvements in hospitalization rates for heart failure, symptom scores, or patient-reported quality of life with dapagliflozin compared with placebo. Safety profiles were consistent with prior SGLT2 inhibitor data, with expected rates of genital infections, volume depletion, and rare cases of ketoacidosis remaining low and manageable under standard monitoring.
Interpreting the Results
The DARE-AF findings challenge the assumption that SGLT2 inhibition would broadly reduce AF recurrence after ablation. While dapagliflozin offers proven benefits in heart failure and metabolic conditions, its impact on post-ablation AF burden appears limited. Researchers stress the importance of distinguishing benefits in comorbidity management from effects on arrhythmia recurrence when evaluating post-procedural therapies.
Clinical Implications
Clinicians should note that adding dapagliflozin specifically to prevent AF recurrence after catheter ablation may not provide the expected advantage. Decision-making should continue to prioritize established post-ablation strategies, including rhythm management, antiarrhythmic therapy tailored to the patient, and close rhythm monitoring. The DARE-AF results may steer future research toward identifying subgroups that could benefit from SGLT2 inhibitors or exploring combination approaches that target AF mechanisms more directly.
Limitations and Future Research
As with any clinical trial, results must be interpreted within the study’s scope. Limitations could include the selected population, duration of follow-up, and adherence rates. Further investigations might explore longer-term outcomes, different dosing strategies, or combinations with other antiarrhythmic therapies to discern any subgroup-specific benefits.
The Bottom Line
DARE-AF adds a crucial data point to the evolving understanding of SGLT2 inhibitors in atrial fibrillation management. While dapagliflozin remains a valuable tool for heart failure and metabolic health, its role in reducing AF recurrence after catheter ablation is not supported by this trial. Individualized post-ablation care remains essential, and ongoing research will clarify whether targeted patient subgroups could reap any AF-related advantages from SGLT2 inhibition in the future.
