What is the clinical evidence from this study?

Study design: Cohort. Population: Cardiac Implantable Electronic Devices (CIEDs) (n=123). Intervention: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) vs. Non-SGLT2i users. Primary outcome: Occurrence of Atrial High-Rate Episodes (AHREs) (HR 0.32, 95% CI 0.10-0.98, p=0.03).

What question did this study set out to answer?

To evaluate the impact of SGLT2i on the incidence of atrial high-rate episodes and major adverse cardiovascular events in patients with cardiac implantable electronic devices.

March 26, 2026Open Access

Association of Sodium-Glucose Cotransporter-2 Inhibitors With Atrial High-Rate Episodes in Patients With Cardiac Implantable Electronic Devices

Q: What does this research mean for the field?

SGLT2 inhibitor use is associated with a significantly lower risk of atrial high-rate episodes (AHREs) in patients with cardiac implantable electronic devices, suggesting a reduction in subclinical atrial arrhythmia burden, though it does not significantly alter the risk of major adverse cardiovascular events. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

SGLT2i use was associated with a 68% lower risk of atrial high-rate episodes compared to nonusers in patients with cardiac implantable electronic devices (HR 0.32).

Key Points

To evaluate the impact of SGLT2i on the incidence of atrial high-rate episodes and major adverse cardiovascular events in patients with cardiac implantable electronic devices.
Retrospective cohort analysis of CIED recipients from January 2020 to December 2024
Patients categorized by SGLT2i exposure
Clinical characteristics and AHRE data collected
Used Cox proportional hazards models to estimate risks for AHREs and MACE
AHREs occurred in 3 patients (SGLT2i group) vs. 54 (non-SGLT2i group)
SGLT2i use correlated with a lower risk of AHRE occurrence (HR 0.32)
Three MACE events in SGLT2i group compared to 20 in non-SGLT2i group

Study Design

Type

Cohort (n=123)

Multicenter

Structured PICO

Does SGLT2i use reduce the occurrence of atrial high-rate episodes in adult patients with cardiac implantable electronic devices?

Population

Adult patients (≥18 years) with cardiac implantable electronic devices (CIEDs) without persistent or permanent AF at baseline, mean age 73.3, 46.3% male.

Intervention

Sodium-glucose cotransporter-2 inhibitors (SGLT2i)

Comparator

No SGLT2i therapy

Outcome

Occurrence of atrial high-rate episodes (AHREs) defined as atrial rate >175 beats per minute lasting ≥5 minutessurrogate

In patients with cardiac implantable electronic devices, SGLT2i use was associated with a 68% reduction in the risk of subclinical atrial high-rate episodes, suggesting a potential novel antiarrhythmic benefit.

Main Result

Effect estimate: HR 0.32 (95% CI 0.10-0.98)

Absolute Event Rate: 40.76% vs 1304.97%

p-value: p=0.03

Limitations

Observational design with potential unmeasured confounding
Small number of SGLT2i users (n=15) limiting statistical power
Missing LVEF and LAVI data requiring multiple imputation
Single-center Thai population limiting generalizability
Retrospective outcome ascertainment introducing potential information bias
Potential differences in AHRE detection sensitivity by device type

Abstract

Background and objective Atrial high-rate episodes (AHREs) are subclinical atrial tachyarrhythmias detected by cardiac implantable electronic devices (CIEDs). Identifying strategies to reduce AHRE occurrence is clinically relevant. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are commonly prescribed for cardiometabolic conditions, and their potential role in subclinical atrial arrhythmias remains to be clarified. The objective of this study is to compare the incidence of AHREs and major adverse cardiovascular events (MACE) between SGLT2i users and nonusers among CIED patients. Methods This retrospective cohort study included CIED recipients from January 2020 to December 2024. Patients were categorized into two groups based on SGLT2i exposure. Clinical characteristics, device parameters, and AHRE data were collected and analyzed. MACE were also recorded. Multiple imputation was applied for missing left ventricular ejection fraction and left atrial volume index data. Propensity score overlap weighting was used to balance baseline covariates. Cox proportional hazards models estimated HRs for AHREs and MACE. Results A total of 123 patients with CIEDs were included, with a mean age of 73.3 ± 13.1 years, and 46.3% were male. Of these, 15 patients received SGLT2i. Overlap propensity score weighting was applied. During follow-up, AHREs occurred in three patients (SGLT2i group) and 54 patients (non-SGLT2i group), corresponding to weighted incidence rates of 40.8 and 1304.9 per 1,000 person-years, respectively. SGLT2i use was associated with a significantly lower risk of AHRE occurrence (HR 0.32, 95% CI 0.10-0.98, p = 0.03). For MACE, three events were observed in the SGLT2i group and 20 in the non-SGLT2i group, yielding a weighted HR of 1.10 (95% CI 0.25-4.96, p = 0.10). Kaplan-Meier survival analysis demonstrated significantly higher AHRE-free survival among patients receiving SGLT2i (log-rank p = 0.03), whereas MACE-free survival did not differ significantly between the groups (p = 0.10). The duration of the longest single AHRE episode was numerically shorter among SGLT2i users, although the difference was not statistically significant. Conclusions SGLT2i use was associated with a significantly lower risk of AHRE occurrence among CIED recipients, suggesting a potential reduction in subclinical atrial arrhythmia burden. However, no significant difference in MACE was observed. These findings highlight a possible antiarrhythmic benefit beyond established cardiovascular effects. Larger prospective studies are warranted to confirm these results.

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