Clinical Impact of SGLT2 Inhibitor After DC Cardioversion in Persistent AF With HFpEF

Patients with persistent atrial fibrillation who meet HFpEF diagnostic criteria (H2FPEF ≥6 or HFA-PEFF ≥5) are screened. After at least 4 weeks of anticoagulation and exclusion of intracardiac thrombus by transesophageal echocardiography, electrical cardioversion is performed with a biphasic defibrillator. Patients who restore sinus rhythm and provide written informed consent are randomized 1:1, stratified by AF duration and left atrial size. All patients receive anticoagulation and antiarrhythmic drugs for 1 month per current guidelines, at the discretion of the treating physician. The primary endpoint is recurrence of atrial tachyarrhythmia at 1 month, assessed by 12-lead ECG or continuous monitoring (≥30 seconds). Analyses follow the intention-to-treat principle, with per-protocol analysis as a sensitivity analysis. The sample size of 200 provides approximately 90% power at a two-sided alpha of 0.05 to detect a difference in recurrence (24% vs 47%).

Inclusion criteria

• Age ≥19 years
• Persistent atrial fibrillation
• H2FPEF score ≥6 or HFA-PEFF score ≥5
• Restoration of sinus rhythm after electrical cardioversion

Exclusion criteria

• Previous use of an SGLT2 inhibitor
• Intracardiac thrombus on transesophageal echocardiography
• Refusal to participate