New Analysis from BIO‑LIBRA Highlights Impact of Modern Heart Failure Therapy on Arrhythmic and Mortality Risk 

• Late-breaking results from the sex‑balanced, BIOTRONIK-funded study presented at EHRA 2026 
• Data shows associations between contemporary guideline-directed therapies and improved outcomes in patients with non‑ischemic cardiomyopathy 

BIOTRONIK Press Release

In a late-breaking trial session at the European Heart Rhythm Association (EHRA) 2026 Congress, principal investigator Valentina Kutyifa, MD, PhD, a tenured Professor of Medicine (Cardiology) at the University of Rochester Medicine, presented new data from the prospective, sex‑balanced BIO‑LIBRA study. The analysis shows that modern guideline-directed medical therapy (GDMT)—specifically angiotensin receptor–neprilysin inhibitors (ARNI) and SGLT2 inhibitors—is associated with a lower risk of ventricular tachyarrhythmias (VT/VF) or death in patients with non‑ischemic cardiomyopathy implanted (NICM) with ICD or CRT‑D devices. 

The BIO‑LIBRA study is one of the largest prospective NICM registries in the U.S. and uniquely enrolled nearly 50% women. This enabled robust, sex‑balanced analysis of arrhythmic risk. In the analysis of 1,000 NICM patients (475 female), researchers examined the relationship between use of ARNI or SGLT2i at baseline and the risk of VT/VF or death: 

SGLT2 inhibitors 

• Associated with significantly lower rates of VT/VF/death (11% vs. 23%) 

• Adjusted analysis showed a 53% lower risk of VT/VF or death (HR 0.47; CI 0.20–1.08) 

• Benefit was driven primarily by reduction in ventricular arrhythmias 

ARNI therapy 

• Associated with significantly lower rates of VT/VF/death 

• Adjusted analysis showed a 24% lower risk of events (HR 0.76; CI 0.56–1.03) 

• Benefit was driven by reduction in all‑cause mortality 

Combined therapy 

• Use of both ARNI and SGLT2i resulted in a 61% lower adjusted risk of VT/VF or death (HR=0.39, CI:0.12-1.23)

• Synergistic effect was observed

“These findings reinforce the importance of modern GDMT in NICM patients—even among those already receiving ICD or CRT‑D therapy,” said Valentina Kutyifa, MD, PhD, Professor of Medicine (Cardiology) in the Department of Medicine at the University of Rochester, Rochester, NY. “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.”

BIO‑LIBRA previously demonstrated important differences in arrhythmic risk between men and women with NICM. The new analysis adds clinical insights and strengthens the evidence base for personalized therapy approaches. 

“This study continues to deliver clinically meaningful insights that inform how we care for patients with non‑ischemic cardiomyopathy,” said Dr. David Hayes, Chief Medical Officer, 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.” 

Through initiatives such as BIO‑LIBRA and BIOWOMEN, BIOTRONIK expands sexspecific cardiovascular data. This research contributes to closing evidence gaps and provides clinicians with clearer guidance for tailoring treatment to female patients. 

About BIOTRONIK 

For over 60 years, BIOTRONIK has stood at the forefront of medical technology, pioneering breakthrough innovations that are transforming the lives of millions affected by heart disease and chronic pain. Rooted in a deep purpose to seamlessly harmonize technology with the human body, we engineer trusted, life-changing therapies through our advanced active implants in Cardiac Rhythm Management, Monitoring, and Neuromodulation, while providing cutting-edge solutions in Electrophysiology. From creating Germany’s first pacemaker in 1963 to breaking new ground in digital technologies and Conduction System Pacing today, BIOTRONIK is continuously raising the bar for quality, performance, and innovation. Headquartered in Berlin, our global reach spans over 100 countries across the Americas, EMEA, and Asia—bringing bold, future-ready solutions that are shaping the next generation of medical technology.