Dapagliflozin vs. Standard Care for the Prevention of Atrial Fibrillation Early Recurrence After Catheter Ablation in Patients With Persistent Atrial Fibrillation: Rationale and Design of the DARE-AF Trial
Key result
Planned DARE-AF trial tests whether dapagliflozin reduces AF burden three months post-ablation.
- n=200
Why the study?
The efficacy of SGLT2 inhibitors for preventing AF recurrence after catheter ablation in persistent AF patients without class I indications remains uncertain.
Does dapagliflozin reduce AF burden in patients with persistent atrial fibrillation undergoing de novo catheter ablation without standard indications for SGLT2 inhibitors?
Key Points
- To evaluate whether dapagliflozin reduces atrial fibrillation burden after catheter ablation in patients with persistent atrial fibrillation who lack standard indications for SGLT2 inhibitors.
- Prospective, parallel-group, randomized, open-label trial planning to enroll 200 patients undergoing de novo catheter ablation for persistent atrial fibrillation.
- Participants without diabetes, heart failure, or chronic kidney disease are randomized 1:1 to dapagliflozin (10 mg daily) or guideline-directed standard care for 3 months.
- Primary endpoint is atrial fibrillation burden at 3 months post-ablation, assessed by 7-day single-lead electrocardiogram patches with blinded adjudication.
- Study protocol and rationale presentation; patient enrollment and quantitative endpoint outcomes are pending trial completion.
- Primary outcome evaluation utilizes two independent blinded cardiologists and an adjudicating electrophysiologist to determine 3-month arrhythmia burden.
Study Design
Type
RCT (n=200)
Blinding
Open-label
Randomization
1:1
Structured PICO
Does dapagliflozin reduce AF burden in patients with persistent atrial fibrillation undergoing de novo catheter ablation without standard indications for SGLT2 inhibitors?
P
Population
200 planned patients with persistent atrial fibrillation undergoing de novo catheter ablation, excluding those with diabetes, heart failure, or chronic kidney disease, followed for 3 months.
I
Intervention
Dapagliflozin 10 mg once daily for 3 months
C
Comparator
Guideline-directed standard care
O
Outcome
AF burden, assessed using 7-day single-lead electrocardiogram patches at 3 months after ablationsurrogate
The DARE-AF trial will evaluate whether dapagliflozin reduces AF burden after catheter ablation in persistent AF patients without standard indications for SGLT2 inhibitors.
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Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“It is not a problem to use dapagliflozin, but we did not see any effect on early recurrence of AFib. However, we remain very confident about its potential, given that a considerable proportion of patients with atrial fibrillation also have heart failure, particularly heart failure with preserved ejection fraction. We believe that a larger, placebo-controlled trial with an extended follow-up period is warranted to more comprehensively evaluate its potential antiarrhythmic benefits.”
“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.”
Implication
DARE-AF will test dapagliflozin for post-ablation AF-burden reduction in persistent AF without diabetes or HF; leaves open extension beyond prior observational data.
Abstract
Atrial fibrillation (AF) recurrence remains common after catheter ablation, particularly in patients with persistent AF (PeAF). Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been associated with a reduced risk of AF recurrence following ablation in patients with diabetes or heart failure. However, their efficacy in patients without class Ⅰ indications for SGLT2i remains uncertain. The DApagliflozin on REcurrence after catheter ablation for Atrial Fibrillation (DARE-AF) trial aims to evaluate the effect of dapagliflozin on AF burden following catheter ablation in patients with PeAF. DARE-AF is a prospective, parallel-group, randomized, open-label controlled trial. This study plans to enroll 200 patients with PeAF undergoing de novo catheter ablation. Patients with class Ⅰ indications for SGLT2i therapy (diabetes, heart failure, or chronic kidney disease) will be excluded. Patients will be randomized 1:1 to receive dapagliflozin 10 mg once daily for 3 months (intervention group) or guideline-directed standard care (control group). The primary endpoint is AF burden, assessed using 7-day single-lead electrocardiogram patches at 3 months after ablation. The primary endpoint will be evaluated by 2 blinded cardiologists with discrepancies adjudicated by a third blinded senior electrophysiologist. The results may provide novel insights into upstream rhythm control strategies in this population.
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Cite This Study
Yang et al. (2026) conducted an RCT in Persistent Atrial Fibrillation (n=200). Dapagliflozin vs. Guideline-directed standard care was evaluated on AF burden, assessed using 7-day single-lead electrocardiogram patches at 3 months after ablation. The DARE-AF trial is a planned randomized study to evaluate whether dapagliflozin reduces AF burden at 3 months post-ablation in patients with persistent atrial fibrillation.