Tiver Kathryn D, Chew Derek P, Tan Jia Y, Lambrakis Kristina, De Pasquale Carmine G, Ganesan Anand N
College of Medicine and Public Health, Flinders University, South Australia, Australia.
Department of Cardiology, Flinders Medical Centre, South Australia, Australia.
Heart Rhythm O2. 2024 Dec 19;6(3):299-306. doi: 10.1016/j.hroo.2024.12.004. eCollection 2025 Mar.
Sodium-glucose cotransporter-2 inhibitors (SGLT2is) have been associated with lower rates of cardiac arrhythmias in analyses. The real-world effect on cardiac arrhythmias is incompletely defined.
The purpose of this study was to determine the effects of SGLT2i on cardiac arrhythmias in a real-world, hospitalized population.
A retrospective cohort study was performed in South Australia, Australia. Patients (n = 882) with type 2 diabetes mellitus (T2DM) on oral diabetic therapy (33.6% females, median age 62.3 years) who received SGLT2i (for T2DM) were identified through public hospital admissions from 2011-2019. Patients were matched with 3282 contemporaneous controls with T2DM who did not receive SGLT2i. Baseline characteristics were adjusted using inverse probability treatment weighting. The primary outcome was incidence of atrial arrhythmias. Secondary outcomes included incidence of ventricular arrhythmias and cardiac arrest at 2 years.
All-cause mortality was higher in the SGLT2i group (hazard ratio [HR] 2.02, 95% confidence interval [CI] 1.55-2.63, <.001) despite propensity matching, highlighting the greater unmeasured comorbidity burden of the SGLT2i-treated group. Despite this, SGLT2i treatment was associated with fewer atrial arrhythmias (HR 0.17, 95% CI 0.07-0.41, <.001) at 2 years. The relationship between SGLT2i use and ventricular arrhythmias (HR 0.25, 95% CI 0.06-1.03, = .055) and cardiac arrest (HR 0.82, 95% CI 0.20-3.45, = .796) did not reach statistical significance.
In this real-world, comorbid inpatient cohort, SGLT2i treatment was associated with a lower incidence of atrial arrhythmias. Prospective randomized trials evaluating SGLT2i as specific atrial fibrillation pharmacotherapy are underway.
在分析中，钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）与较低的心律失常发生率相关。其对心律失常的实际影响尚未完全明确。
本研究旨在确定SGLT2i对真实世界中住院患者心律失常的影响。
在澳大利亚南澳大利亚州进行了一项回顾性队列研究。通过2011 - 2019年公立医院入院记录，确定了882例接受SGLT2i（用于2型糖尿病（T2DM））治疗的口服降糖治疗的2型糖尿病患者（女性占33.6%，中位年龄62.3岁）。将这些患者与3282例同期未接受SGLT2i治疗的2型糖尿病对照患者进行匹配。使用逆概率治疗加权法对基线特征进行调整。主要结局是房性心律失常的发生率。次要结局包括2年时室性心律失常和心脏骤停的发生率。
尽管进行了倾向匹配，但SGLT2i组的全因死亡率更高（风险比[HR] 2.02，95%置信区间[CI] 1.55 - 2.63，P <.001），这突出了SGLT2i治疗组未测量到的合并症负担更重。尽管如此，SGLT2i治疗在2年时与较少的房性心律失常相关（HR 0.17，95% CI 0.07 - 0.41，P <.001）。SGLT2i的使用与室性心律失常（HR 0.25，95% CI 0.06 - （此处原文有误，推测应为1.03），P = 0.055）和心脏骤停（HR 0.82，95% CI 0.20 - 3.45，P = 0.796）之间的关系未达到统计学意义。
在这个真实世界的、合并症住院患者队列中，SGLT2i治疗与较低的房性心律失常发生率相关。正在进行评估SGLT2i作为特定房颤药物治疗的前瞻性随机试验。
