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SGLT2i reduce arrhythmic events in heart failure patients with cardiac implantable electronic devices
Marco Valerio Mariani1, Carlo Lavalle1, Marta Palombi1
1Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences 'Sapienza', University of Rome, Rome, Italy.
Insights
Sodium glucose cotransporter 2 inhibitors (SGLT2i) significantly reduce atrial and ventricular arrhythmias in heart failure patients. This therapy led to a 73.8% decrease in arrhythmic events, improving patient outcomes.
Area of Science:
- Cardiology
- Pharmacology
- Medical Technology
Background:
- Sodium glucose cotransporter 2 inhibitors (SGLT2i) are a cornerstone of heart failure (HF) treatment.
- Their antiarrhythmic effects in patients with HF with reduced ejection fraction (HFrEF) require further clarification.
Purpose of the Study:
- To evaluate the antiarrhythmic efficacy of SGLT2 inhibitors in patients with HFrEF.
- To assess the reduction in atrial and ventricular arrhythmias (AAs and VAs) following SGLT2i initiation.
Main Methods:
- The study included HFrEF patients with implantable cardioverter defibrillators (ICD) or cardiac resynchronization therapy defibrillators (CRT-D).
- Arrhythmia data were collected via remote monitoring for one year before and one year after SGLT2i therapy initiation.
- Incidence of AAs and VAs was compared between the pre-therapy and post-therapy periods.
Main Results:
- A total of 198 patients were enrolled, with 135 experiencing arrhythmic events prior to SGLT2i therapy.
- SGLT2i therapy resulted in a 73.8% reduction in overall arrhythmic events (1353 events pre-therapy vs. 354 post-therapy).
- Significant reductions were observed in total arrhythmias (median 7 to 1), AAs (median 4 to 1), and VAs (median 5.5 to 0), including specific subtypes like atrial fibrillation and ventricular tachycardias (P < 0.001 for all).
Conclusions:
- SGLT2 inhibitors demonstrate significant antiarrhythmic benefits in HFrEF patients with ICD/CRT-D.
- The findings support SGLT2i as a valuable therapeutic option for managing arrhythmias in this patient population.
Background:
Sodium glucose cotransporter 2 inhibitors (SGLT2i) represent one of the four pillars of heart failure (HF) pharmacological therapy.
Objective:
The study aims to clarify SGLT2i antiarrhythmic effect on patients with HF with reduced ejection fraction (HFrEF) in terms of atrial and ventricular arrhythmias (AAs and VAs) reduction.
Methods:
HFrEF carriers of implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT-D) followed by remote monitoring of Policlinico Umberto I of Rome for 1 year before and after SGLT2i therapy initiation were enrolled in the study. We compared the incidence of AAs and VAs as recorded at remote monitoring during 1 year preceding SGLT2i therapy initiation and after 1 year of SGLT2i therapy.
Results:
Among 198 enrolled patients, 135 patients had arrhythmic events before SGLT2i therapy prescription. There were 1353 arrhythmic events recorded in the year before SGLT2i therapy prescription, and 354 events were detected in the year after SGLT2i initiation, with a 73.8% reduction in events number after therapy initiation. After SGLT2i therapy initiation, the median number of total arrhythmic episodes significantly decreased from a median of 7 [3;12] to 1 [0;4] (P value < 0.001), AAs significantly decreased from a median of 4 [3;7] to 1 [0;3] episodes (P value < 0.001) and VAs were reduced from a median of 5.5 [3;10] to 0 [0;2] (P value < 0.001). When considering arrhythmia subtypes, larger reductions were recorded for atrial fibrillation (AF) episodes, reduced from 4 [3;8] to 0 [0;3], non-sustained ventricular tachycardia (NSVT) that decreased from 4 [2;8.75] to 0 [0;2] (P value < 0.001) and for sustained ventricular tachycardia (SVT) that were reduced from 3 [2;4] to 0 [0;1] (P value < 0.001).
Conclusions:
In HFrEF carriers of ICD/CRT-D, the use of SGLT2i resulted in significant reduction of AA and VA events.
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