Effect of sodium glucose cotransporter 2 inhibitors on atrial tachy‐arrhythmia burden in patients with cardiac implantable electronic devices

Abstract

AbstractIntroductionUse of sodium glucose cotransporter 2 inhibitors (SGLT2i) was associated with a reduction in atrial fibrillation hospitalizations. Therefore, we aim to evaluate the effects of SGLT2i on atrial tachy‐arrhythmias (ATA) in patients with cardiac implantable electronic devices (CIEDs).MethodsAll 13 888 consecutive patients implanted with a CIED in two tertiary medical centers were enrolled. Treatment with SGLT2i was assessed as a time dependent variable. The primary endpoint was the total number of ATA. Secondary endpoints included total number of ventricular tachy‐arrhythmias (VTA), ATA and VTA, and death. All events were independently adjudicated blinded to the treatment. Multivariable propensity score modeling was performed.ResultsDuring a total follow‐up of 24 442 patient years there were 62 725 ATA and 10 324 VTA events. Use of SGLT2i (N = 696) was independently associated with a significant 22% reduction in the risk of ATA (hazard ratio [HR] = 0.78 [95% confidence interval {CI} = 0.70–0.87]; p < .001); 22% reduction in the risk of ATA/VTA (HR = 0.78 [95% CI = 0.71–0.85]; p < .001); and with a 35% reduction in the risk of all‐cause mortality (HR = 0.65 [95% CI = 0.45–0.92]; p = .015), but was not significantly associated with VTA risk (HR = 0.92 [95% CI = 0.80–1.06]; p = .26). SGLT2i were associated with a lower ATA burden in heart failure (HF) patients but not among diabetes patients (HF: HR = 0.68, 95% CI = 0.58–0.80, p < .001 vs. Diabetes: HR = 0.95, 95% CI = 0.86–1.05, p = .29; p < .001 for interaction between SGLT2i indication and ATA burden).ConclusionOur real world findings suggest that in CIED HF patients, those with SGLT2i had a pronounced reduction in ATA burden and all‐cause mortality when compared with those not on SGLT2i.