The effect of SGLT-2 inhibitors on ventricular ectopic beat burden in patients with ischemic heart failure and reduced ejection fraction

Heart failure remains one of the leading causes of morbidity and mortality worldwide, and ventricular arrhythmias are among the major determinants of prognosis, particularly in patients with reduced ejection fraction. Among these arrhythmias, ventricular premature contractions (VPCs) contribute not only to increased symptom burden but also to a higher risk of sudden cardiac death in patients with ischemic heart failure. Sodium-glucose cotransporter-2 (SGLT-2) inhibitors, which have recently been incorporated into heart failure treatment owing to their cardioprotective effects, have not yet been clearly evaluated in terms of their potential impact on ventricular arrhythmias. The present study was designed to investigate the possible effects of SGLT- 2 inhibitor use on ventricular premature contraction burden in patients with ischemic heart failure and reduced ejection fraction. A total of 58 patients with an ejection fraction of 40% or less, who had been on stable medical therapy for at least one month and had available 24-hour holter rhythm monitoring data, were included in this study. The groups using and not using SGLT-2 inhibitors were comparable in terms of age, gender, ejection fraction, renal function, and comorbidities. All holter analyses were performed at a single center using the same device and software system. For each patient, the total number of ventricular beats, number of ventricular premature beats, and the ratio of ventricular premature beats to total beats were calculated. The results demonstrated no statistically significant difference between the groups regarding the 24-hour number or frequency of ventricular premature contractions. There were also no significant differences between the groups in demographic, clinical, or laboratory parameters. The strengths of the study include the application of homogeneous patient selection criteria, the exclusion of confounding factors such as thyroid disease, advanced renal failure, antiarrhythmic drug use, and electrolyte imbalance, and the use of a standardized holter analysis protocol within a single center. 55 The findings suggest that SGLT-2 inhibitors do not provide a significant short-term reduction in ventricular premature contraction burden. However, considering the homogeneity of the study population, this result appears to be independent of baseline patient characteristics. Nevertheless, the long-term use of SGLT-2 inhibitors may potentially reduce arrhythmic burden through mechanisms related to cardiac reverse remodelling, attenuation of myocardial fibrosis, and improved autonomic balance, effects that may become more apparent with extended follow-up.