Type 2 diabetes mellitus is associated with a high risk of atherosclerosis and subsequent cardiovascular events, and an increase in life-threatening arrhythmia events, but little data is currently available regarding therapeutic strategies to improve prognosis in these patients.

The recent EMPA-REG OUTCOME study showed that administration of the sodium–glucose transporter 2 (SGLT2) inhibitor empagliflozin (EMPA) significantly suppressed cardiovascular death including sudden cardiac death, but the mechanisms underlying the beneficial effects of EMPA remain unknown.

It is well known that SGLT2 inhibitors increase blood ketone bodies, which have been suggested to have sympatho-suppressive effects. We therefore designed the current clinical trial titled “Placebo-controlled, double-blind study of empagliflozin and implantable cardioverter-defibrillator (EMPA-ICD) in patients with type 2 diabetes” to investigate the antiarrhythmic effects of EMPA.