Favorable outcomes of SGLT2 inhibitor use in pacemaker recipients: a population-based study

Pacemaker recipients are predisposed to heart failure (HF), yet evidence guiding preventive pharmacotherapy in this population remains unexplored. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have redefined HF management across a broad spectrum of cardiometabolic phenotypes. This study evaluated the association between SGLT2i therapy and clinical outcomes after pacemaker implantation for atrioventricular block. Patients receiving conventional pacemakers between 2016 and 2024 were retrospectively analyzed and stratified by baseline SGLT2i therapy. Exclusions included sinus node dysfunction or iatrogenic pacing indications, single-chamber devices, and estimated glomerular filtration rate < 20 mL/min/1.73m2. Events within 3 months post-implantation were omitted to reduce peri-procedural confounding. After propensity score matching, Cox regression assessed associations between SGLT2i use and all-cause mortality and HF hospitalization. Among 11,518 eligible patients, propensity score matching yielded two well-balanced cohorts of 1,226 SGLT2i users and non-SGLT2i users. Over three years, death occurred in 124 (10.1%) in the SGLT2i users and in 194 (15.8%) in the non-SGLT2i group (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.50 to 0.78; P < 0.001). HF hospitalization occurred in 132 (10.7%) in the SGLT2i group, and in 280 (22.8%) in the non-SGLT2i group (HR, 0.50; 95% CI, 0.41 to 0.62; P < 0.001). Subgroup analyses demonstrated consistent effects across strata. SGLT2i therapy was associated with reduced risk of all-cause mortality and HF–related hospitalizations following pacemaker implantation. Future randomized studies are needed to confirm this association.