Dapagliflozin to Reduce Early Recurrence After Catheter Ablation for Atrial Fibrillation: The DARE-AF Randomized Clinical Trial

Background: Observational studies have suggested that sodium-glucose cotransporter 2 inhibitors (SGLT2i) are associated with a lower risk of atrial fibrillation (AF) recurrence after catheter ablation in AF patients with concomitant diabetes, heart failure or chronic kidney disease. However, no randomized trial to date has tested whether SGLT2i reduces AF recurrence post-ablation in patients without established indications. We therefore investigated the effect of dapagliflozin on the prevention of early recurrence of AF after catheter ablation in patients without current indications for SGLT2i. Methods: DARE-AF (Dapagliflozin on Recurrence After Catheter Ablation for Atrial Fibrillation) trial was a prospective, open-label, parallel-assignment randomized controlled trial that enrolled 200 persistent AF patients between July 2024 and March 2025, scheduled to undergo a first catheter ablation procedure and no established indications for dapagliflozin (diabetes, heart failure, or chronic kidney disease). Patients were randomly assigned in a 1:1 ratio to dapagliflozin 10mg once daily for 3 months after the ablation or control. The primary endpoint was AF burden at 3 months after ablation, assessed by 7-day single-lead electrocardiogram patches. Secondary outcomes included time to events, quality of life, and improvement of atrial remodeling. Results: A total of 200 patients (mean age 58.5 years; 19.5% women; 29.0% with persistent AF ≥1 year) were randomized, and 198 patients (98 in the dapagliflozin group, 100 in the control group) were included in the primary analysis. At 3 months post-ablation, the difference in AF burden was insignificant between the dapagliflozin group and the control group (7.5 ± 23.6% vs. 8.1 ± 25.5%; p = 0.48). Atrial arrhythmia recurrence occurred in 29 patients (29.6%) in the dapagliflozin group and 28 patients (28.0%) in the control group (HR, 1.11; 95% CI, 0.66–1.86; p = 0.70). No significant between-group differences were observed in changes in quality of life or left atrial diameter. Conclusions: Three-month treatment of dapagliflozin did not reduce the early recurrence of arrhythmia after catheter ablation in persistent AF patients.