Cardioprotective Effects of Sodium-Glucose Cotransporter-2 Inhibitors in Patients undergoing Ventricular Tachycardia (VT) Ablation: A Propensity-Matched Cohort Study

Introduction: Cardiovascular disease is one of the leading causes of death in patients with type 2 diabetes mellitus (T2DM). Sodium glucose cotransporter 2 inhibitors (SGLT2i) have proven to be beneficial in improving cardiovascular outcomes and reducing all cause mortality in patients with T2DM. We aimed to investigate the effect SGLT2i use on cardiovascular outcomes inpatients with T2DM who underwent VT ablation. Methods: A retrospective cohort study was conducted using the TriNetX US Collaborative Network, a federated network of healthcare organizations across the United States. Adults (aged 18 to 80 years) with T2DM who underwent catheter ablation for ventricular tachycardia were included. Patients were stratified based on exposure to SGLT2i. Propensity score matching (1:1) was used to balance baseline characteristics. Outcomes were assessed within 3 years following the index ablation procedure. Patients with a recorded occurrence of the outcome prior to the index event were excluded from each respective outcome analysis. Kaplan Meier analysis and log rank tests were used for statistical comparisons with significance set at p<0.05. Results: SGLT2 inhibitor nonusers exhibited significantly higher hazard ratios (HR) for various adverse outcomes. The HR for all cause mortality was 1.422 (95% CI: 1.279;1.581), while the HR for cardiac arrest was 1.409 (95% CI: 1.135;1.750). Additionally, the HR for post-ablation cardioversion was 1.188 (95% CI: 1.042;1.355), and the utilization of amiodarone after ablation had an HR of 1.240 (95% CI: 1.106;1.391). In contrast, the hazard ratios for redo ablation (1.039, 95% CI: 0.956;1.128), visits for ICD adjustments (0.916, 95% CI: 0.766;1.096), post ablation use of any class of antiarrhythmics (1.139, 95% CI: 0.906;1.431), and lidocaine (0.911, 95% CI: 0.775;1.070) were less definitive. Conclusion: SGLT2i nonuser group was associated with significantly higher risks of several adverse outcomes following ablation, including a 42% increase in all cause mortality and a 41% increase in cardiac arrest. Nonusers also had higher rates of post ablation cardioversion and amiodarone use. However, no significant differences were found in redo ablation, ICD adjustments, or the use of other antiarrhythmics. These findings suggest a potential protective role of SGLT2 inhibitors in selective cardiovascular outcomes. Further studies are warranted to confirm these associations and investigate the underlying mechanisms.