Effect of Sglt2 Inhibitors on the Arrhythmic Burden in Heart Failure

Abstract 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.