Exploring The Risk of Ventricular Arrhythmia and Sudden Cardiac Death with SGLT2 Inhibitors in Heart Failure Patients: A Comprehensive Systematic Review and Bayesian Network Meta-Analysis

Presenter: Mohd Turzo Rahman

This Bayesian network meta-analysis evaluated the risk of ventricular arrhythmia and sudden cardiac death (SCD) in heart failure patients treated with SGLT2 inhibitors across 22 randomized controlled trials involving 73,963 patients.

Empagliflozin, Canagliflozin and Dapagliflozin showed the greatest reduction in SCD risk, with hazard ratios of 0.70, 0.72, and 0.73 respectively. For ventricular arrhythmia, Bexagliflozin ranked highest (RR: 0.33), followed by Canagliflozin. SUCRA rankings supported these findings. The analysis used MCMC methods and accounted for study variability. Overall, SGLT2 inhibitors appear to reduce arrhythmic risk in heart failure, though further research is needed to confirm long-term safety and efficacy.

Competing Risks of Ventricular Tachyarrhythmias and Mortality in Advanced Heart Failure: Impact of Left Ventricular Ejection Fraction

Presenter:  Alon Barsheshet

This study analyzed 5,168 heart failure patients with implantable cardioverter defibrillators (ICDs) across five major trials, stratified by left ventricular ejection fraction (LVEF).

Patients with LVEF ≤20% had significantly higher risks of ventricular tachycardia/fibrillation (VT/VF), fast VT/VF, and appropriate ICD shocks compared to those with higher LVEF, even after adjusting for competing non-arrhythmic mortality. Specifically, VT/VF incidence was 28% in the lowest LVEF group vs 20% in the highest. Additionally, all-cause mortality was 1.5 times greater in patients with LVEF ≤20%. These findings underscore the importance of ICD therapy in patients with severely reduced LVEF to mitigate arrhythmic and mortality risks.

Impact of Physical Activity Restriction in Patients with Arrhythmogenic Dysplasia on The Development of Cardiovascular Risk Factors

Presenter: Aurora Martinez Ballesta

This study investigated the impact of physical activity restriction in 72 patients with arrhythmogenic dysplasia over a 25-year period.

Using accelerometry and patient interviews, researchers found a significant reduction in physical activity—averaging 122 minutes less per day—after diagnosis. Although differences in activity levels among patients with cardiovascular risk factors (e.g., diabetes, hypertension, dyslipidemia, chronic kidney disease) were observed, they were not statistically significant. The findings suggest that fear of physical exertion may lead to sedentarism, potentially increasing cardiovascular risk. Promoting safe, tailored physical activity is essential to mitigate secondary health risks in this patient population.

Characteristics of High Success Rate Antitachycardia Pacing for Ventricular Tachycardia in Implantable Cardioverter-Defibrillator Recipients: True Septal Right Ventricular Lead Position as A Predictor

Presenter: Satoshi Yanagisawa

This study analyzed 1,468 antitachycardia pacing (ATP) episodes in 119 ICD/CRTD recipients to identify factors associated with successful ventricular tachycardia (VT) termination.

A slow VT rate (<188 bpm), CRTD device use, and true septal right ventricular (RV) lead placement were independently linked to higher ATP success rates. True septal lead positioning yielded the highest termination rate (79.8%) and shorter pacing QRS intervals, suggesting more efficient myocardial capture. These findings emphasize the importance of precise RV lead placement during device implantation, as it is the only modifiable factor that significantly enhances ATP efficacy and may improve clinical outcomes in ICD patients.

The Quality of Care and Long-Term Mortality of Patients with ST-Elevation Myocardial Infarction and Cardiac Devices: A Nationwide Cohort Study

Presenter: Nick Weight

This nationwide cohort study analyzed 322,890 STEMI patients in England and Wales from 2005 to 2019, including 2,118 with cardiac devices.

Patients with devices were older and more likely female. After multivariate adjustment, they were significantly less likely to receive timely reperfusion (door-to-balloon time <60 minutes; aOR 0.61) and had higher all-cause mortality at five years (aHR 1.16), even after excluding early deaths (aHR 1.25). These findings suggest that cardiac device presence may negatively impact acute care delivery and long-term outcomes in STEMI patients, highlighting the need for tailored management strategies to improve care and survival in this growing population.

Prophylactic Catheter Ablation in Asymptomatic Adult and Pediatric Patients with Wolff-Parkinson-White Pattern: A Systematic Review and Meta-Analysis

Presenter: Guilherme Dagostin de Carvalho

This meta-analysis evaluated the effectiveness of prophylactic catheter ablation (CA) in asymptomatic patients with Wolff-Parkinson-White (WPW) pattern.

Across five studies involving 336 patients, CA significantly reduced arrhythmia recurrence (RR = 0.27, 95% CI: 0.09–0.82, p = 0.021) compared to conservative management. However, no statistically significant differences were found in the risk of sudden death, ventricular fibrillation, or atrioventricular reentrant tachycardia. These findings suggest that while prophylactic CA may lower arrhythmia recurrence in asymptomatic WPW patients, it does not significantly impact mortality or severe arrhythmic events, indicating the need for individualized risk-benefit assessment before intervention.

Ref: ESC Congress 2025, 29^thAug- 1^st Sept 2025, Spain