Association of SGLT2 Inhibitor Use with All-Cause Mortality Following CIED Implantation for Conduction Disease in Patients with Preserved LVEF: A Retrospective Cohort Study.

Background/Objectives: Patients receiving a cardiac implantable electronic device (CIED) for conduction disease may remain at substantial long-term risk despite preserved systolic function at implantation. The prognostic association of sodium-glucose cotransporter-2 (SGLT2) inhibitor use in this population is uncertain. We therefore examined the relationship between early documented SGLT2 inhibitor use and subsequent all-cause mortality in patients with preserved left ventricular ejection fraction (LVEF) undergoing CIED implantation for conduction disease. Methods: In this retrospective single-center cohort study, we screened consecutive adults who underwent CIED implantation for conduction disease between January 2018 and June 2024. Patients with LVEF ≥ 50% and complete clinical, laboratory, electrocardiographic, and echocardiographic data were included. SGLT2 inhibitor exposure was defined as documented initiation or active use within 3 months after implantation. The primary endpoint was all-cause mortality. Associations were evaluated using multivariable Cox proportional-hazards regression and Kaplan-Meier analyses. Results: Among 2176 screened patients, 540 fulfilled the eligibility criteria, of whom 206 (38.1%) had documented SGLT2 inhibitor exposure. During a median observation period of 64.2 months (range, 7-90 months), 185 deaths occurred. SGLT2 inhibitor exposure was associated with a lower adjusted hazard of death (HR, 0.48; 95% CI, 0.38-0.69; p < 0.001). Survival also differed between exposure groups in the overall cohort (log-rank p = 0.006) and in patients without either heart failure or diabetes mellitus (log-rank p = 0.020). Conclusions: In patients with preserved LVEF undergoing CIED implantation for conduction disease, documented SGLT2 inhibitor use was independently associated with lower all-cause mortality. These observational findings are hypothesis-generating and warrant confirmation in prospective studies.
Diabetes
Care/Management

Authors

Arabaci Arabaci, Ozkan Ozkan, Guven Guven, Gecit Gecit, Arslan Arslan, Arslan Arslan
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