Biotronik has announced in a press release that—via a late-breaking trial session at the annual congress of the European Heart Rhythm Association (EHRA; 12–14 April 2026, Paris, France)—principal investigator Valentina Kutyifa (University of Rochester, Rochester, USA) recently presented new data from the prospective, sex‑balanced BIO‑LIBRA study.
The analysis showed that modern guideline-directed medical therapy (GDMT)—specifically angiotensin receptor-neprilysin inhibitors (ARNIs) and SGLT2 inhibitors—is associated with a lower risk of ventricular tachyarrhythmias (VT/VF) or death in patients with non‑ischaemic cardiomyopathy (NICM) receiving implantable cardioverter defibrillator (ICD) or cardiac resynchronisation therapy defibrillator (CRT‑D) devices.
The BIO‑LIBRA study is one of the largest prospective NICM registries in the USA, and has “uniquely” enrolled a patient population of which nearly 50% are women, according to Biotronik. The company notes that this enabled robust, sex‑balanced analysis of arrhythmic risk.
In an analysis of 1,000 NICM patients, researchers examined the relationship between use of ARNIs or SGLT2 inhibitors at baseline, and the risk of VT/VF or death.
SGLT2 inhibitors were associated with significantly lower rates of VT/VF or death compared to rates seen in patients who did not receive SGLT2 inhibitors (11% vs 23%, respectively), with adjusted analyses showing a 53% lower risk of VT/VF or death (hazard ratio [HR], 0.47; confidence interval [CI], 0.2–1.08). Researchers found that this benefit was driven primarily by a reduction in ventricular arrhythmias.
Similarly, therapy with ARNIs was associated with significantly lower rates of VT/VF or death compared to without ARNIs, with adjusted analyses indicating a 24% lower risk of events (HR, 0.76; CI, 0.56–1.03). This benefit was driven by a reduction in all‑cause mortality, the researchers report.
Furthermore, combined therapy—use of both ARNI therapy and SGLT2 inhibitors—resulted in a 61% lower adjusted risk of VT/VF or death (HR, 0.39; CI, 0.12–1.23), with a synergistic effect being observed.
“These findings reinforce the importance of modern GDMT in NICM patients—even among those already receiving ICD or CRT‑D therapy,” said Kutyifa. “SGLT2 inhibitors appear to reduce arrhythmic events, while ARNI therapy is associated with improved survival. These synergistic effects support routine use of both drug classes in eligible patients.”
According to Biotronik, BIO‑LIBRA previously demonstrated important differences in arrhythmic risk between men and women with NICM—and this new analysis adds clinical insights and strengthens the evidence base for personalised therapy approaches.
“This study continues to deliver clinically meaningful insights that inform how we care for patients with non‑ischaemic cardiomyopathy,” commented David Hayes, chief medical officer for Biotronik. “This new analysis highlights how advanced medical therapy and device therapy work together to reduce arrhythmic and mortality risk. We are proud to support research that directly contributes to improving patient outcomes.”
