Key result
SGLT2 inhibitors are linked to ~52% lower mortality after CIED implantation in preserved LVEF.
Why the study?
Patients receiving a CIED for conduction disease remain at substantial long-term risk despite preserved systolic function, but the prognostic association of SGLT2 inhibitor use in this population is uncertain.
Does SGLT2 inhibitor use reduce all-cause mortality in patients with preserved LVEF undergoing CIED implantation for conduction disease?
Cohort (n=540)
No
Does SGLT2 inhibitor use reduce all-cause mortality in patients with preserved LVEF undergoing CIED implantation for conduction disease?
In patients with preserved LVEF undergoing CIED implantation for conduction disease, early SGLT2 inhibitor use was independently associated with significantly lower long-term all-cause mortality.
Answers are grounded in this paper and cite their sources.
Supports hypothesis of benefit in preserved-LVEF CIED patients; leaves open confirmation in randomized trials.
Background/Objectives: Patients receiving a cardiac implantable electronic device (CIED) for conduction disease may remain at substantial long-term risk despite preserved systolic function at implantation. The prognostic association of sodium–glucose cotransporter-2 (SGLT2) inhibitor use in this population is uncertain. We therefore examined the relationship between early documented SGLT2 inhibitor use and subsequent all-cause mortality in patients with preserved left ventricular ejection fraction (LVEF) undergoing CIED implantation for conduction disease. Methods: In this retrospective single-center cohort study, we screened consecutive adults who underwent CIED implantation for conduction disease between January 2018 and June 2024. Patients with LVEF ≥ 50% and complete clinical, laboratory, electrocardiographic, and echocardiographic data were included. SGLT2 inhibitor exposure was defined as documented initiation or active use within 3 months after implantation. The primary endpoint was all-cause mortality. Associations were evaluated using multivariable Cox proportional-hazards regression and Kaplan–Meier analyses. Results: Among 2176 screened patients, 540 fulfilled the eligibility criteria, of whom 206 (38.1%) had documented SGLT2 inhibitor exposure. During a median observation period of 64.2 months (range, 7–90 months), 185 deaths occurred. SGLT2 inhibitor exposure was associated with a lower adjusted hazard of death (HR, 0.48; 95% CI, 0.38–0.69; p < 0.001). Survival also differed between exposure groups in the overall cohort (log-rank p = 0.006) and in patients without either heart failure or diabetes mellitus (log-rank p = 0.020). Conclusions: In patients with preserved LVEF undergoing CIED implantation for conduction disease, documented SGLT2 inhibitor use was independently associated with lower all-cause mortality. These observational findings are hypothesis-generating and warrant confirmation in prospective studies.
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Arabacı et al. (2026) conducted a cohort in Cardiac conduction disease requiring CIED implantation with preserved LVEF (n=540). SGLT2 inhibitor vs. No SGLT2 inhibitor use was evaluated on All-cause mortality (HR 0.48, 95% CI 0.38-0.69, p=<0.001). SGLT2 inhibitor exposure was independently associated with a 52% lower risk of all-cause mortality (HR 0.48) in patients with preserved LVEF undergoing CIED implantation for conduction disease.
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