Empagliflozin significantly attenuates sotalol-induced QTc prolongation in rats

Sotalol is a class III antiarrhythmic drug commonly used in various arrhythmia treatments. However, due to its potent potassium channel inhibition, it can prolong the QT interval and lead to malignant arrhythmias. Empagliflozin is an inhibitor of sodium‑glucose cotransporter 2 (SGLT2) and has a positive effect on cardiovascular outcomes. Since the effect of empagliflozin on the activation of potassium channels is unknown, there is no recommendation regarding the coadministration of these drugs.

The study aimed to evaluate the possible protective effects of empagliflozin on sotalol‑induced QT prolongation.

We randomized 24 rats into 4 groups. The control group received only physiological saline, the EMPA group, empagliflozin; the SOT group, sotalol; and the EMPA+SOT group, empagliflozin and sotalol. PR and QT intervals and heart rates were measured under anesthesia at baseline and at 1, 2, and 3 hours in lead II.

In the SOT group, the QT and QTc intervals as well as T‑wave duration were statistically longer, whereas heart rates were lower than in the control group (P <0.001 for all parameters). Empagliflozin ameliorated sotalol‑induced QT and QTc prolongation in the EMPA+SOT group. The QT interval, T‑wave duration, and QTc interval were shorter, and the heart rate was greater than in the SOT group (P <0.001, P = 0.002, P <0.001, and P <0.001, respectively).

Empagliflozin significantly ameliorates sotalol‑induced QT prolongation and could be used safely with sotalol in clinical practice. Future clinical trials might recommend the routine use of empagliflozin to prevent QTc prolongation in diabetic patients receiving sotalol.