Effect of sacubitril/valsartan and SGLT2 inhibitors on arrhythmia burden in ICD patients.

BACKGROUND

This study aimed to examine whether the use of sodium-glucose co-transporter 2 inhibitors (SGLT2i) and/or sacubitril/valsartan in individuals with an implantable cardioverter-defibrillator (ICD) was associated with differences in pathological rhythm burden, specifically atrial fibrillation (AF), ventricular tachycardia (VT), and ventricular fibrillation (VF), during follow-up.

METHODS

Data from 275 patients who underwent ICD implantation between 2022 and 2025 were analyzed retrospectively. The primary endpoint was change in device-detected arrhythmic burden, categorized as unchanged/increased, 0-50% reduction, 50-100% reduction, or arrhythmia-free status during 12-month follow-up. The secondary endpoint was change in LVEF (ΔEF). Associations between medical therapies and EF change were assessed using multivariable linear regression models adjusted for demographic and clinical covariates.

RESULTS

Overall, mean LVEF increased significantly during follow-up (ΔEF 9.7 ± 8.7%, p < 0.001). In adjusted analyses, ARNI use was independently associated with greater EF improvement (B = 10.647, p < 0.001), whereas SGLT2i therapy alone was not significantly associated with ΔEF. In unadjusted analyses, both ARNI and SGLT2i therapies were associated with a higher likelihood of substantial reduction in arrhythmic burden and arrhythmia-free status (p < 0.001 for both). Patients receiving combined ARNI and SGLT2i therapy demonstrated the highest proportion of arrhythmia-free status during follow-up.

CONCLUSION

In this retrospective cohort of ICD recipients with HFrEF, ARNI therapy was independently associated with greater improvement in LVEF, while both ARNI and SGLT2i use were associated with lower device-detected arrhythmic burden in unadjusted analyses. Prospective studies are required to determine causality and clarify the independent antiarrhythmic effects of contemporary guideline-directed therapies in ICD populations.