Iranian Heart Journal

Iranian Heart Journal

Empagliflozin Effects on Supraventricular Arrhythmias in Heart Failure Patients With Implantable Cardioverter-Defibrillator

Document Type : Original Article

Authors
Majid Shohrati 1
Morteza Khodaparast 2
Mahdi Bagheri 1
Mohammad Tayyebi 3
1 Department of Clinical Pharmacy, Faculty of Pharmacy, Baqiyatallah University of Medical Sciences, Tehran, IR Iran.
2 Atherosclerosis Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, IR Iran.
3 Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran.
Abstract
Background: Empagliflozin, a sodium-glucose cotransporter-2 inhibitor (SGLT2i), is a primary pharmacological therapy for chronic heart failure (CHF). Notably, it has demonstrated anti-arrhythmic properties in some experimental and human studies. This clinical trial aimed to evaluate the effect of empagliflozin on supraventricular arrhythmias in patients with CHF and an implantable cardioverter-defibrillator (ICD).
 
Methods: In a before-and-after clinical trial conducted in Tehran, Iran, 62 patients were administered empagliflozin 10 mg/d for 12 weeks. The frequency and proportion of supraventricular arrhythmias, including atrial fibrillation (AF), atrial flutter (AFL), and inappropriate ICD therapies during the 12-week treatment period were compared with the 12 weeks before enrollment. Hospitalizations due to CHF, blood glucose levels, lipid profiles, and vital signs were also assessed as secondary outcomes.
 
Results: Empagliflozin significantly reduced the frequency of supraventricular tachycardia and AF/AFL per hour (P = 0.028 and P = 0.038, respectively). However, the frequency of inappropriate therapies and the proportion of patients with supraventricular arrhythmias or inappropriate ICD therapies did not change significantly. Empagliflozin also reduced hospitalizations due to CHF (P = 0.008). Furthermore, fasting blood sugar, HbA1c, triglycerides, systolic blood pressure, diastolic blood pressure, heart rate, and high-density lipoprotein levels improved after 12 weeks (P < 0.001, P < 0.003, P < 0.013, P < 0.001, P < 0.032, P < 0.009, and P < 0.008, respectively).
 
Conclusions: Empagliflozin exhibits anti-arrhythmic properties for AF/AFL in individuals with CHF and an ICD. These anti-arrhythmic effects may be attributed to its positive impact on hyperglycemia, hypertension, dyslipidemia, and hospitalizations due to CHF. (Iranian Heart Journal 2025; 26(2): 66-76)
Keywords
Arrhythmia
Atrial fibrillation
Empagliflozin
Implantable cardioverter-defibrillator
SGLT2 inhibitor
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Iranian Heart Journal
Volume 26, Issue 2
Spring 2025
Pages 66-76