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March 26, 2026CureusOpen Access

Association of Sodium-Glucose Cotransporter-2 Inhibitors With Atrial High-Rate Episodes in Patients With Cardiac Implantable Electronic Devices

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Why the study?

Identifying strategies to reduce atrial high-rate episodes is clinically relevant, and the potential role of SGLT2 inhibitors in subclinical atrial arrhythmias remains to be clarified.

Does SGLT2i use reduce the occurrence of atrial high-rate episodes in adult patients with cardiac implantable electronic devices?

Population

123 patients with CIEDs

Comparison

SGLT2i users vs nonusers

Design

Retrospective cohort study

Key result

SGLT2i use was associated with a 68% lower risk of atrial high-rate episodes compared to nonusers in patients with cardiac implantable electronic devices (HR 0.32).

Authors

WTWichid ThirakraisriTSThipsukhon SathapanasiriPPPariwat Pengkaew

Discussion

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Overview

May support SGLT2i antiarrhythmic effects in CIED patients; extends known benefits but is hypothesis-generating pending RCTs.

Key Points

  • To evaluate the impact of SGLT2i on the incidence of atrial high-rate episodes and major adverse cardiovascular events in patients with cardiac implantable electronic devices.
  • Retrospective cohort analysis of CIED recipients from January 2020 to December 2024
  • Patients categorized by SGLT2i exposure
  • Clinical characteristics and AHRE data collected
  • Used Cox proportional hazards models to estimate risks for AHREs and MACE
  • AHREs occurred in 3 patients (SGLT2i group) vs. 54 (non-SGLT2i group)
  • SGLT2i use correlated with a lower risk of AHRE occurrence (HR 0.32)
  • Three MACE events in SGLT2i group compared to 20 in non-SGLT2i group

Study Design

Type

Cohort (n=123)

Multicenter

No

Structured PICO

Does SGLT2i use reduce the occurrence of atrial high-rate episodes in adult patients with cardiac implantable electronic devices?

P
Population
Adult patients (≥18 years) with cardiac implantable electronic devices (CIEDs) without persistent or permanent AF at baseline, mean age 73.3, 46.3% male.
I
Intervention
Sodium-glucose cotransporter-2 inhibitors (SGLT2i)
C
Comparator
No SGLT2i therapy
O
Outcome
Occurrence of atrial high-rate episodes (AHREs) defined as atrial rate >175 beats per minute lasting ≥5 minutessurrogate

Main Result

Effect estimate: HR 0.32 (95% CI 0.10-0.98)

Absolute Event Rate: 40.76% vs 1304.97%

p-value: p=0.03

In patients with cardiac implantable electronic devices, SGLT2i use was associated with a 68% reduction in the risk of subclinical atrial high-rate episodes, suggesting a potential novel antiarrhythmic benefit.

Limitations

  • Observational design with potential unmeasured confounding
  • Small number of SGLT2i users (n=15) limiting statistical power
  • Missing LVEF and LAVI data requiring multiple imputation
  • Single-center Thai population limiting generalizability
  • Retrospective outcome ascertainment introducing potential information bias
  • Potential differences in AHRE detection sensitivity by device type
  • Multiple imputation introduces additional uncertainty
  • Single-center Thai population may not generalize to other ethnicities or healthcare settings
  • Retrospective outcome ascertainment may have missed events or misclassified outcomes
  • Heterogeneity in device type with higher proportion of CRT-D devices among SGLT2i users

Cite This Study

Thirakraisri et al. (2026) conducted a cohort in Cardiac Implantable Electronic Devices (CIEDs) (n=123). Sodium-glucose cotransporter-2 inhibitors (SGLT2i) vs. Non-SGLT2i users was evaluated on Occurrence of Atrial High-Rate Episodes (AHREs) (HR 0.32, 95% CI 0.10-0.98, p=0.03). SGLT2i use was associated with a 68% lower risk of atrial high-rate episodes compared to nonusers in patients with cardiac implantable electronic devices (HR 0.32).

synapsesocial.com/papers/69c4cd80fdc3bde448919f94https://doi.org/10.7759/cureus.105732
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Effect of sodium glucose cotransporter 2 inhibitors on atrial tachy‐arrhythmia burden in patients with cardiac implantable electronic devices2023 · 10 citations
  2. 2Impact of SGLT2 Inhibitors on Device-Detected Arrhythmias: a Preliminary Study2025 · 1 citations
  3. 3More Disease, Fewer Arrhythmic Events: A Competing‐Risk Signal for SGLT2 Inhibitors in ICD Recipients2026
  4. 4Association of sodium-glucose cotransporter 2 inhibitors with risk of major adverse cardiovascular events in type 2 diabetes patients with acute coronary syndrome: a propensity score‑matched analysis2024 · 16 citations
  5. 5Impact on ventricular arrhythmic burden of SGLT2 inhibitors in patients with chronic heart failure evaluated with cardiac implantable electronic device monitoring2024 · 11 citations