Overview: Aiming to Lower AF Recurrence With SGLT2 Inhibition
The DARE-HF trial, conducted in New Orleans, tested whether dapagliflozin, an SGLT2 inhibitor, could reduce the burden of atrial fibrillation (AF) after catheter ablation. AF remains a leading heart rhythm disorder, and recurrence after ablation poses a persistent challenge for patients and clinicians. While SGLT2 inhibitors are proven to benefit heart failure and metabolic health in many settings, their role in preventing AF recurrence after ablation has been uncertain.
Key Findings: No Reduction in AF Burden Post-Ablation
In the DARE-HF trial, patients undergoing catheter ablation for AF were randomized to receive dapagliflozin or placebo, with primary endpoints focusing on AF burden over a defined follow-up period. The study found no statistically significant difference in AF episodes between the dapagliflozin group and the control group. This suggests that, for patients who have already undergone ablation, adding an SGLT2 inhibitor does not meaningfully lessen the likelihood or frequency of AF recurrence in the short to intermediate term.
Clinical Implications: Where Dapagliflozin Fits in AF Care
The trial’s results indicate that dapagliflozin should not be relied upon as an intervention specifically aimed at reducing post-ablation AF burden. Clinicians should continue to tailor post-procedure strategies around rhythm monitoring, lifestyle modification, and established antiarrhythmic approaches to manage AF recurrence. SGLT2 inhibitors may still offer other cardiovascular benefits, such as reducing heart failure hospitalization and improving metabolic health, but their role as a targeted antiarrhythmic after ablation appears limited based on this study.
Context Within the Broader Evidence Base
Prior research has explored the antiarrhythmic potential of SGLT2 inhibitors, with mixed results. The DARE-HF trial contributes a critical data point by specifically focusing on post-ablation AF burden. While some studies have suggested metabolic or hemodynamic improvements could indirectly influence rhythm stability, the DARE-HF findings underscore that post-procedural AF management remains multifaceted and may not be significantly altered by SGLT2 inhibition alone.
What Comes Next: Research Directions and Patient Care
Researchers may investigate whether subgroups—such as patients with coexisting heart failure, varying AF types, or different ablation strategies—could experience any benefit from SGLT2 inhibitors after ablation. Additionally, future trials might examine combination approaches that pair rhythm-focused therapies with metabolic interventions to reduce AF recurrence risk. For now, dapagliflozin should be considered for its established benefits in heart failure and metabolic disease, not as a specific post-ablation AF-burden reducer.
Bottom Line: Practical Takeaways for Clinicians and Patients
For clinicians, the DARE-HF results emphasize sticking to evidence-based post-ablation protocols focused on rhythm control, anticoagulation decisions, risk factor modification, and monitoring. For patients, the news is that dapagliflozin does not appear to lower AF recurrence after ablation, though it may still offer other health advantages. Ongoing research will clarify whether any subset of patients could derive AF-related benefit from SGLT2 inhibition in conjunction with ablation or other therapies.
