Dr Chao Jiang:

I'm Chao Jiang from Beijing Anzhen Hospital.

Dr Zhao Zixu:

I'm Zhao Zixu from Anzhen Hospital.

What was the reasoning behind this trial?

Dr Chao Jiang:

As we know, catheter ablation has become the first-line therapy of rhythm control in patients with atrial fibrillation. However, a large proportion of patients also suffered recurrence after the catheter ablation. The SGLT2 inhibitor, a new agent for the anti-diabetes drugs, shows significant cardiovascular protection in patients with diabetes, heart failure and chronic kidney disease.

And some post-hoc analysis from the clinical trials have shown that SGLT2 inhibitors have a significant effect to reduce the AF recurrence after catheter ablation. And also our prospective China-AF registry study shows that the SGLT2 inhibitor use was associated with a significant reduced recurrence after catheter ablation in patients with atrial fibrillation.

However, there are no randomised clinical trials to test whether SGLT2 inhibitors could reduce AF reccurrence in patients without diabetes, heart failure or chronic kidney disease. So we conducted the first DARE-AF randomised trial to test this assumption.

What was the study design and patient population?

Dr Zhao Zixu:

So we focused on patients with persistent AFib but without current indication for SGLT2, mostly patients without diabetes, heart failure and CKD. So after recruiting, patients were divided into a dapagliflozin group and a control group to receive, so for patients in the innovation group, they will receive three-months dapagliflozin for treatment. So the primary outcome of our study is AFib burden monitored by ECG patch for seven days.

What were the key findings announced at AHA 25?

So unfortunately, there's no significant difference of AFib burden between two groups, and there seems no impact of the reduction of AFib recurrence in the dapagliflozin group.

In the secondary outcome, we did not find that dapagliflozin reduced the size of left atrial, and there's no impact of dapagliflozin on the quality of life in patients in the individual group compared to the control group.

What further research is needed, and what are the next steps?

Dr Chao Jiang:

I think the major limitation of our study is that the treatment of dapagliflozin is short, only three months. So future randomised clinical trials are warranted to test about long-term treatment with SGLT2 inhibitors, maybe one-year treatment of SGLT2 inhibitor could reduce the risk of atrial fibrillation recurrence after catheter ablation. We should cast that question. And also, we know that the heart failure is the most common comorbidities and the leading cause of death in patients with atrial fibrillation.

However, the heart failure, especially the heart failure with preserved ejection fraction, are often unrecognised in patients with atrial fibrillation. So, future study warranted to test whether SGLT2 inhibitors could reduce the risk of heart failure hospitalisation or mortality in patients with atrial fibrillation.