Empagliflozin in paroxysmal or persistent atrial fibrillation: a possible antiarrhythmic effect

Abstract

Background: Many studies have highlighted an increased risk of developing atrial fibrillation (AF) in diabetic patients. The SGLT2 inhibitors, in addition to glycaemic control, have shown pleiotropic effects on the cardiovascular system, proving to be particularly advantageous in patients with heart failure. In this study we evaluated a group of patients with paroxysmal AF (PAF) or persistent AF (PeAF) affected by type 2 diabetes and treated with empagliflozin. Methods: This is a case-crossover study obtained from our database of patients affected by PAF or PeAF. We extracted 23 consecutive subjects ICD wearers and affected by diabetes that started treatment with empagliflozin during the follow-up. Results: All enrolled patients were ICD wearers because at high risk of sudden cardiac death and received amiodarone; empagliflozin was added during follow-up for the treatment of diabetes. We evaluated the recurrence of PAF and the days free from AF one year before and one year after starting treatment with empagliflozin. The recurrence of AF was significantly lower after starting empagliflozin than before the treatment (p: 0.001). Conclusion: Our data suggest that empagliflozin is able to reduce the recurrences of AF in diabetic patients with PAF or PeAF. Further studies might demonstrate an antiarrhythmic effect of empagliflozin and change the therapeutic approach in subjects at high risk of AF.