Effect of sodium glucose cotransporter 2 inhibitors on atrial tachy‐arrhythmia burden in patients with cardiac implantable electronic devices

INTRODUCTION: Use of sodium glucose cotransporter 2 inhibitors (SGLT2i) was associated with a reduction in atrial fibrillation hospitalizations. Therefore, we aim to evaluate the effects of SGLT2i on atrial tachy-arrhythmias (ATA) in patients with cardiac implantable electronic devices (CIEDs). METHODS: All 13 888 consecutive patients implanted with a CIED in two tertiary medical centers were enrolled. Treatment with SGLT2i was assessed as a time dependent variable. The primary endpoint was the total number of ATA. Secondary endpoints included total number of ventricular tachy-arrhythmias (VTA), ATA and VTA, and death. All events were independently adjudicated blinded to the treatment. Multivariable propensity score modeling was performed. RESULTS: During a total follow-up of 24 442 patient years there were 62 725 ATA and 10 324 VTA events. Use of SGLT2i (N = 696) was independently associated with a significant 22% reduction in the risk of ATA (hazard ratio HR = 0. 78 95% confidence interval CI = 0. 70-0. 87; p <. 001) ; 22% reduction in the risk of ATA/VTA (HR = 0. 78 95% CI = 0. 71-0. 85; p <. 001) ; and with a 35% reduction in the risk of all-cause mortality (HR = 0. 65 95% CI = 0. 45-0. 92; p =. 015), but was not significantly associated with VTA risk (HR = 0. 92 95% CI = 0. 80-1. 06; p =. 26). SGLT2i were associated with a lower ATA burden in heart failure (HF) patients but not among diabetes patients (HF: HR = 0. 68, 95% CI = 0. 58-0. 80, p <. 001 vs. Diabetes: HR = 0. 95, 95% CI = 0. 86-1. 05, p =. 29; p <. 001 for interaction between SGLT2i indication and ATA burden). CONCLUSION: Our real world findings suggest that in CIED HF patients, those with SGLT2i had a pronounced reduction in ATA burden and all-cause mortality when compared with those not on SGLT2i.