Dapagliflozin on Recurrence After Catheter Ablation For Atrial Fibrillation - DARE-AF

Nov 09, 2025

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Author/Summarized by Author:
Ufuk Vardar, MD
Summary Reviewer:
Fred M. Kusumoto, MD, FACC
Original Posted Date:
11/09/2025
On this page:
References
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Contribution To Literature:

The DARE-AF trial found that a 3-month course of dapagliflozin failed to prevent early atrial fibrillation (AFib) recurrence in patients without current indications for SGLT2 inhibitors.

Study Design:

DARE-AF was a prospective, open-label, single-center (Beijing, China), parallel-assignment randomized controlled trial in which patients with persistent AFib without established indications for SGLT2 inhibitors were randomly assigned in a 1:1 ratio following first catheter ablation for AFib to receive dapagliflozin 10 mg once daily for 3 months or standard care (control) (100 patients in each group).

  • Total number of enrollees: 200
  • Duration of follow-up: 3 months
  • Mean patient age: 58.5 years
  • Demographics: 19.5% women, mean BMI 27 kg/m2

Inclusion criteria:

  • Adults 18-80 years with persistent AFib for ≤5 years
  • Scheduled to undergo a first (de novo) catheter ablation procedure for AFib

Exclusion criteria:

  • Class I indications for SGLT2 inhibitors (diabetes, heart failure, or chronic kidney disease with estimated glomerular filtration rate 20-60 mL/min/1.73 m2)
  • Unable to restore sinus rhythm despite cardioversion after catheter ablation
  • Left atrial anterior-posterior diameter ≥50 mm
  • Severe structural heart disease (hypertrophic cardiomyopathy, rheumatic heart disease, dilated cardiomyopathy)
  • AFib secondary to reversible causes (such as hyperthyroidism, acute infection, etc.)
  • Other arrhythmias mandating antiarrhythmic drug therapy
  • End-stage renal failure or dialysis
  • Previous allergic reactions to dapagliflozin

Other salient features/characteristics:

  • Catheter ablation: 97.5% radiofrequency energy, 2.5% pulse field energy
  • All underwent bilateral pulmonary vein isolation; additional ablation performed in 93.5%
  • AFib recurrence assessed by 7-day single-lead electrocardiogram patches

Principal Findings:

Primary outcome:

  • AFib burden at 3 months post-ablation: 7.5% in dapagliflozin group vs. 8.1% in control group (p=0.48; geometric mean difference, 0.98 [95% CI, 0.68-1.41]; p=0.89)

Secondary outcomes:

  • AFib burden at 3 months post-ablation divided by proportions: <0.1% in 83.7% vs. 81.0%; 0.1-9.9% in 4.1% vs. 8.0%; ≥10% in 12.2% vs. 11.0% for dapagliflozin vs. control (p=0.51)
  • Patients with AFib episode duration ≥1 hour: 15.3% with dapagliflozin vs. 17.0% with control (p=0.75)
  • AFib recurrence during the 3 months post-ablation: 29.5% with dapagliflozin vs. 28.0% with control (hazard ratio, 1.11 [95% CI, 0.66-1.86]; p=0.70)
  • Mean changes of left atrial anterior-posterior diameter: –4.9 mm with dapagliflozin vs. –4.7 mm with control (mean difference, –0.17 [95% CI, –1.40 to +1.06; p=0.87)
  • Mean changes of AFib effect on quality-of-life scores: –29.6 with dapagliflozin vs. –28.2 with control (mean difference: –1.36 [95% CI, –7.80 to +5.08; p=0.68)

Safety outcomes:

  • 21 serious adverse events occurred during the study period (11 with dapagliflozin, 10 with control), including 2 deaths in the dapagliflozin group.
  • 2 adverse events (1 due to hypotension, 1 due to urinary tract or genital infection) were attributed to dapagliflozin treatment in the intervention group.

Interpretation:

This single-center randomized controlled trial demonstrated that in persistent AFib patients without established indications for SGLT2 inhibitors, 3-month treatment with dapagliflozin failed to reduce the early recurrence of arrhythmias or improve atrial remodeling or quality of life after first ablation. These findings suggest that in the absence of cardiometabolic comorbidities (such as diabetes, heart failure, chronic kidney disease, etc.), SGLT2 inhibitors may not provide additional benefit in reducing AFib recurrence beyond mitigating comorbidity-related atrial remodeling.

References

Jiang C, Zhao Z, Yang Z, et al. Dapagliflozin to reduce early recurrence after catheter ablation for atrial fibrillation: the DARE-AF randomized clinical trial. Circulation. November 2025. doi:10.1161/circulationaha.125.077447

Presented by Zixu Zhao, MD, at the American Heart Association Scientific Sessions (AHA 2025), New Orleans, LA, Nov. 9, 2025.

Resources

Clinical Topics: Arrhythmias and Clinical EP, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: AHA Annual Scientific Sessions, AHA25, Arrhythmias, Cardiac