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July 26, 2026Pacing and Clinical Electrophysiology

More Disease, Fewer Arrhythmic Events: A Competing‐Risk Signal for SGLT2 Inhibitors in ICD Recipients

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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?

Population

62 primary-prevention ICD recipients

Comparison

SGLT2i at implantation vs no SGLT2i

Design

Single-center prospectively maintained registry cohort study

Follow-up

Median 752 days

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.

Authors

JGJuan P. GuzmanMCM CapobiancoPUPedro Diaz Uberti

Discussion

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Member takes

Overview

May support fewer appropriate shocks despite comorbidities in ICD recipients; leaves open causality and practice change pending larger trials.

Key Points

  • This research assesses the relationship between SGLT2 inhibitors and arrhythmic events in patients with implanted ICDs.
  • Prospectively maintained registry of primary-prevention ICD recipients (n=62)
  • Cumulative incidence functions estimated using the Aalen-Johansen method
  • Competing risks analysis performed for appropriate ICD shocks versus death without shock.
  • 22 first appropriate shocks recorded over a median follow-up of 752 days
  • SGLT2i associated with lower hazard of appropriate shock (HR 0.34; 95% CI 0.13-0.91; p=0.031)
  • Results consistent in HFrEF sub-cohort (HR 0.24; 95% CI 0.06-0.92; p=0.037).

Study Design

Type

Cohort (n=62)

Multicenter

No

Structured PICO

Does SGLT2 inhibitor use reduce the incidence of appropriate ICD shocks in primary-prevention ICD recipients?

P
Population
62 primary-prevention ICD recipients followed for a median of 752 days.
E
Exposure
SGLT2 inhibitors at the time of ICD implantation (n=36).
C
Comparator
No SGLT2 inhibitors at the time of ICD implantation.
O
Outcome
First appropriate ICD shock for sustained ventricular tachyarrhythmia (with death without prior shock as a pre-specified competing event).hard clinical

Main Result

Hazard Ratio: 0.34 (95% CI 0.13–0.91)

p-value: p=0.031

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.

Limitations

  • Single-center design
  • Confounding by arrhythmic substrate (baseline NSVT)
  • Requires confirmation in larger cohorts
  • single-center
  • confounding by arrhythmic substrate (baseline NSVT)
  • requires confirmation in larger cohorts

Cite This Study

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.

synapsesocial.com/papers/6a65a72fd3aea3239cd782behttps://doi.org/10.1111/pace.70371
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Also Consider

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

  1. 1Ventricular arrhythmia events in patients with implantable cardioverter-defibrillator before and after the treatment with sodium-glucose co-transporter 2 inhibitors2024
  2. 2Impact on ventricular arrhythmic burden of SGLT2 inhibitors in patients with chronic heart failure evaluated with cardiac implantable electronic device monitoring2024 · 11 citations
  3. 3Effect of sodium-glucose cotransporter 2 inhibitors (SGLT2) on the occurrence of tachyarrhythmias in patients with heart failure with reduced ejection fraction2026
  4. 4Impact of SGLT2 Inhibitors on Device-Detected Arrhythmias: a Preliminary Study2025 · 1 citations
  5. 5Association of Sodium-Glucose Cotransporter-2 Inhibitors With Atrial High-Rate Episodes in Patients With Cardiac Implantable Electronic Devices2026