Impact of SGLT2 Inhibitors on Device-Detected Arrhythmias: a Preliminary Study

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated significant cardiovascular benefits beyond glycemic control, with emerging evidence suggesting antiarrhythmic effects. This prospective study aimed to establish a study protocol for a future trial assessing the impact of SGLT2i on arrhythmia burden in patients with implantable cardiac devices without heart failure with reduced ejection fraction (HFrEF) and to provide preliminary data on clinical trends.

Patients with cardiac implantable electrical devices (CIEDs) who underwent routine device interrogation were allocated to either SGLT2i treatment or standard care without SGLT2i based on clinical judgment and patient preference, grounded by existing evidence of potential anti-arrhythmic benefits. Arrhythmic events, including atrial high-rate episodes (AHRE), atrial fibrillation (AF) and non-sustained ventricular tachycardia (NSVT), were assessed at baseline and after a one-year follow-up. Levels of N-terminal pro b-type natriuretic peptide (NT-proBNP) or brain natriuretic peptide (BNP) were also evaluated.

Seventeen patients completed follow-up (eight in the SGLT2i group, nine in the control group). The proportion of patients with arrhythmic events remained unchanged in the control group, whereas a trend toward reduced arrhythmic burden was observed in the SGLT2i group, albeit without achieving statistical significance. Additionally, three patients in the control group progressed to permanent AF, whereas no such progression was observed in the SGLT2i-treated group. BNP values showed a significant reduction in the SGLT2i group after treatment.

This study outlines a feasible protocol for CIED-based arrhythmia monitoring and provides preliminary evidence suggesting a potential antiarrhythmic effect of SGLT2i. Larger randomized controlled trials are needed to confirm these findings.