Department of Medicine, Division of Cardiology, Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York, USA.
Department of Cardiology, Clinical Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA.
J Cardiovasc Electrophysiol. 2023 Aug;34(8):1595-1604. doi: 10.1111/jce.15996. Epub 2023 Jul 15.
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).
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.
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).
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.
钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2i）的使用与心房颤动住院率降低有关。因此，我们旨在评估 SGLT2i 对心脏植入式电子设备（CIED）患者房性心动过速-心律失常（ATA）的影响。
纳入在两家三级医疗中心植入 CIED 的 13888 例连续患者。SGLT2i 治疗被评估为时间依赖性变量。主要终点是 ATA 的总数。次要终点包括室性心动过速-心律失常（VTA）、ATA 和 VTA 的总数以及死亡。所有事件均独立于治疗进行盲法裁决。进行多变量倾向评分建模。
在总计 24442 患者年的随访期间，发生了 62725 次 ATA 和 10324 次 VTA 事件。使用 SGLT2i（N=696）与 ATA 风险显著降低 22%独立相关（风险比[HR] = 0.78 [95%置信区间 {CI} = 0.70-0.87]；p < 0.001）；ATA/VTA 风险降低 22%（HR = 0.78 [95% CI = 0.71-0.85]；p < 0.001）；全因死亡率降低 35%（HR = 0.65 [95% CI = 0.45-0.92]；p = 0.015），但与 VTA 风险无显著相关性（HR = 0.92 [95% CI = 0.80-1.06]；p = 0.26）。SGLT2i 与心力衰竭（HF）患者的 ATA 负担降低相关，但与糖尿病患者无关（HF：HR = 0.68，95% CI = 0.58-0.80，p < 0.001 与糖尿病：HR = 0.95，95% CI = 0.86-1.05，p = 0.29；p < 0.001 用于 SGLT2i 适应证和 ATA 负担之间的交互作用）。
我们的真实世界研究结果表明，与未使用 SGLT2i 的患者相比，HF 患者使用 SGLT2i 后 ATA 负担和全因死亡率显著降低。
