Key result
SGLT2 inhibitor use at ICD implantation was associated with a lower hazard of first appropriate ICD shock (HR 0.34; 95% CI 0.13-0.91; p=0.031), though attenuated after adjusting for baseline NSVT.
Why the study?
The association of SGLT2 inhibitors with device-adjudicated ventricular arrhythmias in real-world primary-prevention ICD recipients remains poorly characterized.
Does SGLT2 inhibitor use reduce the incidence of appropriate ICD shocks in primary-prevention ICD recipients?
Cohort (n=62)
No
Does SGLT2 inhibitor use reduce the incidence of appropriate ICD shocks in primary-prevention ICD recipients?
SGLT2 inhibitor use at the time of primary-prevention ICD implantation is associated with fewer appropriate shocks, though this association may be confounded by baseline arrhythmic burden.
Answers are grounded in this paper and cite their sources.
May support fewer appropriate shocks despite comorbidities in ICD recipients; leaves open causality and practice change pending larger trials.
INTRODUCTION: SGLT2 inhibitors (SGLT2i) reduce heart failure events across the ejection fraction spectrum, but their association with device-adjudicated ventricular arrhythmias in real-world primary-prevention ICD recipients remains poorly characterized. METHODS AND RESULTS: In a prospectively maintained primary-prevention ICD registry (n = 62; January 2021 onward), 36 patients (58%) were receiving SGLT2i at implantation. The primary endpoint was first appropriate ICD shock for sustained ventricular tachyarrhythmia; death without prior shock was the pre-specified competing event. Cumulative incidence functions were estimated by the Aalen-Johansen method. Over a median follow-up of 752 days, 22 first appropriate shocks occurred. SGLT2i-treated patients had more advanced structural disease (median LVEF 31% vs. 51%) and lower baseline arrhythmic burden (NSVT 36% vs. 69%) than untreated patients. Cumulative incidence of appropriate shock differed significantly between groups (Gray test p = 0.008). In a cause-specific Cox model adjusted for LVEF and amiodarone use, SGLT2i was associated with a lower hazard of appropriate shock (HR 0.34; 95% CI 0.13-0.91; p = 0.031), confirmed by Fine-Gray subdistribution analysis (sHR 0.36; 95% CI 0.13-0.99; p = 0.047). Results were consistent in an HFrEF sub-cohort (LVEF 35% or less; HR 0.24; 95% CI 0.06-0.92; p = 0.037). Adjustment for baseline NSVT attenuated the association to non-significance (HR 0.43; p = 0.12), reflecting confounding by arrhythmic substrate. CONCLUSION: In this single-center competing-risk analysis, SGLT2i use at ICD implantation was associated with fewer device-adjudicated arrhythmic events. Whether this reflects direct electrophysiological modification or favorable patient selection requires confirmation in larger cohorts.
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Guzman et al. (2026) conducted a cohort in Primary-prevention ICD recipients (n=62). SGLT2 inhibitors vs. Untreated patients was evaluated on First appropriate ICD shock for sustained ventricular tachyarrhythmia (HR 0.34, 95% CI 0.13-0.91, p=0.031). SGLT2 inhibitor use at ICD implantation was associated with a lower hazard of first appropriate ICD shock (HR 0.34; 95% CI 0.13-0.91; p=0.031), though attenuated after adjusting for baseline NSVT.
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