Background: Sodium-glucose co-transporter 2 inhibitors (SGLT2-i) have shown significant cardiovascular benefits in patients with and without type 2 diabetes mellitus, however, their potential beneficial effect on arrhythmic burden has been poorly investigated.
Objective: this observational study explores the potential arrhythmic burden reduction in a cohort of heart failure (HF) patients treated with SGLT2 inhibitors, regardless of ejection fraction.
Methods: 29 consecutive HF patients, who underwent cardioverter defibrillator (ICD) implantation for at least 6 months before the enrollment, were followed up 6 months later SGLT2-i initiation. Every single event was analyzed by Cardiologists experienced in home monitoring systems and has been categorized as follow: atrial high-rate episodes (AHRE), SVT (Sustained Ventricular Tachycardia), non-sustained Ventricular Tachycardia (NSVT), Premature Ventricular Beat burden (PVC), anti tachycardia pacing (ATP), proper and inappropriate shocks. All data were collected in an arbitrary observational time of 6 months before and after SGLT2-i therapy has been initiated.
Results: in the 6 months before SGLT2-i introduction the following data were observed: 211 AHRE in 6 patients (21% of patients who experienced at least an event), 1 SVT (3%), 8 NSVT in 5 patients (17%), 2 ATP in 1 patient (3%), 1 inappropriate ICD shock. Considering the limited sample size which affected statistical power, after SGLT2-I initiation a trend of arrhythmic burden reduction was observed: 554 AHRE in 3 patients (10%), 1 SVT (3.4%), 7 NSVT in 3 patients (10%), 2 ATP in 1 patient, 1 appropriate shock. Despite an absolute increase in total AHRE episodes, patients who experienced at least an event halved (from 21% to 10%). Moreover, a remarkable NSVT reduction was observed both as patients who experienced the event (17% to 10%) along with absolute number of events.
Conclusions: SGLT2-is have been showing strong improvements on cardiovascular events, especially HF hospitalization and CV death. Besides, the burden of cardiac arrhythmias is still a matter of debate, especially in the field of ventricular burden. Our study delineates a positive effect of SGLT2i, showing a trend in reduction of the arrhythmic event, both in AHRE and NSVT. Expanding sample size of this study is mandatory to support the benefit of SGLT2i on arrhythmic burden, suggesting a charming pharmacodynamic model of these still unknown, extraordinary drugs.