Effect of sodium-glucose cotransporter 2 inhibitors (SGLT2) on the occurrence of tachyarrhythmias in patients with heart failure with reduced ejection fraction
J J Serrano Silva, L Mateos De La Haba, J Fernandez Rebollo, E Coppo, A Del Rio LechugaAbstract
Introduction and purpose
Sodium-glucose cotransporter 2 inhibitors (SGLT2) have been shown to be effective in the management of heart failure. However, their impact on the onset of tachyarrhythmias in these patients remains unclear. The aim of this study is to determine whether SGLT2 protect against the development of tachyarrhythmias in patients with heart failure with reduced left ventricular ejection fraction (HFrEF).
Methods
A prospective cohort study was conducted including patients from our Area with implanted devices for left heart failure between 2014 and 2022, with a 2-year follow-up after implantation and evaluations every 6 months at the device clinic. Demographic variables, cardiovascular risk factors (CVRF), history of arrhythmias, pharmacological treatment, and incidence of arrhythmic events were analyzed, stratifying the sample according to treatment with SGLT2 inhibitors. Cohort comparability was assessed, and multivariate models were built to control for potential confounders.
Results
Eighty-five patients were included, with a mean age of 70.46±9.69 years; 82% were male. Thirty-six patients (42.4%) received SGLT2 therapy. The main implanted device was an ICD (45.9%), most commonly for primary prevention (58.8%). In the treatment-stratified analysis, patients receiving SGLT2 inhibitors were more frequently treated with sacubitril–valsartan (p=0.000) and ARNi (p=0.03), and less frequently with ACE inhibitors (p=0.006) and ARBs (p=0.01). A detailed descriptive analysis is shown in Table 1. Significant differences were found in the occurrence of tachyarrhythmic events after 2 years of follow-up (p=0.039; OR 3.12; 95% CI 1.06–9.20), independent of other pharmacological treatments, CVRF, arrhythmic history, or other study variables. Only the etiology of heart failure (ischemic vs. non-ischemic) remained in the logistic regression model due to its borderline statistical significance (p=0.054; OR 2.56; 95% CI 0.95–6.92).
Conclusions
SGLT2 appear to protect against the onset of tachyarrhythmias in patients with HFrEF, with such events being three times more frequent among those not receiving SGLT2 therapy, irrespective of other heart failure medications and baseline comorbidities.Onset of tachyarrhytmiasBaseline characteristics