Effect of Dapagliflozin on Left Atrial Strain Parameters in Diabetic Patients with Paroxysmal Atrial Fibrillation

Background: Atrial fibrillation (AF) is a common arrythmia in diabetes mellitus (DM). Left atrial strain (LAS) and electromechanical delay (EMD) are important AF predictors. Aim: To investigate the effect of dapagliflozin added to the standard antidiabetic treatment on LAS and EMD in type 2 DM (T2DM) patients with paroxysmal AF. Subjects and Methods: Diabetic patients in sinus rhythm with history of paroxysmal AF diagnosed by Holter electrocardiogram (ECG) or hospitalization were assigned into 2 groups. Dapagliflozin group: dapagliflozin 10 mg added to the standard antidiabetic treatment. Control group: standard antidiabetic treatment without added Sodium-Glucose-Cotransporter inhibitors (SGLT2i). Both groups were on beta blockers to prevent AF recurrence. We assessed baseline characteristics, echocardiography, LAS, EMD, and paroxysmal AF prevalence in both groups. Results: Dapagliflozin group (113 patients) has a postive improvement in diastolic function (E/e’ reduced from 9.9±2.4 to 7.8±1.8, P< 0.01), LA reservoir strain (26.5±7.9% to 28.9±3.8%, P< 0.015), LA contraction strain (10.8±4.9% to 12.2±5.9%, P< 0.021), and interatrial EMD (29.75±7.53 to 21.72±4.51 milliseconds, P< 0.029) at 12-months follow-up. Likewise, paroxysmal AF has occurred in 7.1% of dapagliflozin group vs 13.8% in control group at 12-months follow-up, P value Conclusion: Dapagliflozin addition to the standard antidiabetic treatment was associated with reduction of LA strain and interatrial electromechanical delay in type 2 DM patients who have paroxysmal AF. Moreover, this was associated with reduction of paroxysmal AF recurrence as documented by Holter ECG or hospitalization.