Clinical effects of dapagliflozin in patients with type 2 diabetes mellitus and paroxysmal atrial fibrillation
A.E. Bagriy, O.A. Prikolota, A.V. Prikolota, E.S. Mikhailichenko, I.A. Golodnikov, O.N. Bagriy, K.A. Kotova
1) M. Gorky Donetsk National Medical University, Donetsk, DPR;
2) Donetsk Regional Clinical Territorial Medical Association, Donetsk, DPR
Background. The incidence of atrial fibrillation (AF) in type 2 diabetes mellitus (DM2) is approximately one third higher than in individu- als without DM. The place of sodium-glucose co-transporter-2 inhibitors in patients with DM2 in combination with atrial fibrillation (AF) needs to be clarified.
Objective. Evaluation of the effect of dapagliflozin compared with other hypoglycemic drugs on the frequency of AF episodes, left atrial (LA) size, and clinical and laboratory parameters in patients with DM2 and paroxysmal AF in a randomized, prospective, open-label study.
Methods. 68 patients with DM2 and paroxysmal AF were followed-up. For the treatment of AF, a rhythm control strategy was chosen; approaches to cardioversion and subsequent treatment were in line with current domestic and international recommendations. After randomization, group A (37 patients) was selected for the use of the combination of metformin and dapagliflozin (10 mg/day) as hypo- glycemic therapy, and group B (31 patients) – for the use of metformin in combination with sulfonylurea drugs. The follow-up period was
11.4 (5.9) months.
Results. The treatment contributed to the effective achievement of target glycemic levels by all patients and was satisfactorily tolerated. Relapses of AF paroxysms during the follow-up period occurred in 8 (21.6%) patients in group A and in 15 (48.4%) patients in group B (P<0.05). During treatment in both groups, there was a significant decrease in the LA volume index, body mass index, functional class of chronic heart failure (CHF), microalbuminuria, glycated hemoglobin and blood pressure levels, as well as an increase in left ventricular ejection fraction; these favorable changes were more pronounced in group A than in group B (P<0.01).
Conclusion. The use of dapagliflozin in patients with DM2 and paroxysmal AF was satisfactorily tolerated, contributed to a decrease in the size of the LA and a decrease in the frequency of arrhythmia relapses, and was also associated with achieving adequate glycemic control and improving the clinical picture of CHF.
About the Autors
Corresponding author: Alina V. Prikolota, Cand. Sci. (Med.), Teaching Assistant at the Department of Therapy, FIPO n.a. professor A.I. Dyadyk, Gorky Donetsk National Medical University, Donetsk, DPR; firstname.lastname@example.org