Pakistan Journal of Pharmaceutical Sciences

Abstract: Background: Atrial fibrillation (AF) represents the most common type of persistent arrhythmia in older adults. This research assesses the impact of integrating sodium-glucose cotransporter 2 inhibitors (SGLT2i), specifically dapagliflozin, into standard care on atrial remodeling and the recurrence of AF in elderly patients with multiple co-existing conditions. Objective: The findings aim to inform improved treatment strategies for this patient population. Method: The study enrolled 174 elderly persistent AF (PAF) patients, comparing 88 (research group) who received dapagliflozin plus standard care against 86 controls on standard care only. The primary endpoints were the incidence of AF recurrence and the magnitude of change in left atrial diameter (LAD) at the 12-month mark. Secondary outcomes included levels of myocardial fibrosis biomarkers (PIIINP, PICP, TGF-?1), inflammation markers (hs-CRP, IL-6), cardiac function tests (NT-proBNP, LVEF), quality of life (6MWT, ADL) and safety monitoring. Results: The research group showed a lower rate of AF recurrence at 12 months than the control group (P<0.05); this benefit was even greater in patients with diabetes (P<0.05). LAD decreased after treatment in both groups and the decrease was greater in the research group (P<0.001). The research group also achieved greater reductions in serum PIIINP, PICP, TGF-?1, hs-CRP and IL-6 compared to the control group (P<0.05). Furthermore, a more substantial drop in NT-proBNP was observed (P<0.05). LVEF remained stable in the research group but declined slightly in the control group (P<0.05). Quality of life metrics also favored the research group, which showed superior gains in both 6MWT distance and ADL scores (P<0.05). The safety profile was similar between groups, with no statistically significant difference in adverse effects (P>0.05). Conclusion: These results indicate that adding dapagliflozin to standard care is a promising treatment option for PAF.