Empagliflozin may reduce ventricular arrhythmias in patients with type 2 diabetes, ICDs
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Key takeaways:
- In patients with type 2 diabetes and an ICD or CRT-D, empagliflozin reduced the number of ventricular arrhythmias vs. placebo.
- The study was smaller than expected due to the COVID-19 pandemic.
PHILADELPHIA — In the EMPA-ICD trial, patients with type 2 diabetes and an implantable cardioverter defibrillator had fewer ventricular arrhythmias at 24 weeks when assigned empagliflozin compared with placebo.
For the investigator-initiated trial, presented at the American Heart Association Scientific Sessions, Shinya Fujiki, MD, from the department of cardiovascular medicine at Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Japan, and colleagues enrolled 150 patients (mean age, 71 years; 83% men; mean HbA1c, 7.1%) with type 2 diabetes and an ICD or cardiac resynchronization therapy defibrillator (84% for secondary prevention) to determine whether the SGLT2 inhibitor empagliflozin (Jardiance, Boehringer Ingelheim/Eli Lilly) could reduce the number of ventricular arrhythmias compared with placebo.
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“Patients with diabetes are known to be at high risk of ventricular arrhythmias,” Fujiki said during a presentation. “Several mechanisms associated with [SGLT2 inhibitors] have been reported, and one hypothesis is that these drugs have antiarrhythmic effects. The results of a post hoc analysis of the DAPA-HF trial and a meta-analysis suggested that SGLT2 inhibitors reduce the risk of ventricular arrhythmias. However, at present, no prospective studies have directly examined whether SGLT2 inhibitors reduce the number of ventricular arrhythmias. So, the purpose of the EMPA-ICD trial was to compare the number of ventricular arrhythmias 24 weeks before and after empagliflozin treatment in patients with diabetes treated with ICD/CRT-D in a randomized clinical trial.”
The trial had lower-than-expected enrollment because of the COVID-19 pandemic and several patients discontinued the trial, Fujiki said, noting the analysis was conducted on an intention-to-treat basis.
The primary endpoint of change in the total number of ventricular arrhythmias recorded by ICD or CRT-D from 24 weeks before treatment with empagliflozin or placebo to 24 weeks after treatment favored the empagliflozin group (change in empagliflozin group, –1.69; change in placebo group, +1.79; between-group difference, –1.07; 95% CI, –1.29 to –0.86; P by generalized estimating equations < .001), Fujiki said during the presentation.
The total number of ventricular premature complexes did not change much in the empagliflozin group but increased in the placebo group, Fujiki said, noting that the difference in number of double ventricular premature complexes at 24 weeks after treatment was statistically significant (P < .001).
“The results of the EMPA-ICD trial indicate that empagliflozin reduces the number of ventricular arrhythmias compared to placebo in patients with type 2 diabetes treated with ICD/CRT-D,” Fujiki said during the presentation.
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Fujiki S, et al. FS.01. Innovations in EP care. Presented at: American Heart Association Scientific Sessions; Nov. 11-13, 2023; Philadelphia.
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