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Sodium-Glucose Cotransporter-2 Inhibitors and Arrhythmias: A Meta-Analysis of 38 Randomized Controlled Trials

Vikash Jaiswal1, Song Peng Ang2, Danisha Kumar3

  • 1Department of Cardiovascular Research, Larkin Community Hospital, South Miami, Florida, USA.

JACC. Advances
|February 22, 2025
PubMed

Insights

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) reduce the risk of atrial arrhythmia and sudden cardiac death (SCD) in patients with type 2 diabetes, heart failure, or kidney disease. However, SGLT2i did not show a reduced risk for ventricular arrhythmia.

Area of Science:

  • Cardiology
  • Endocrinology
  • Nephrology

Background:

  • Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are recognized for reducing heart failure hospitalizations and cardiovascular mortality.
  • The impact of SGLT2i on arrhythmia and sudden cardiac death (SCD) remains less understood.

Purpose of the Study:

  • To investigate the association between SGLT2i use and the risk of arrhythmias and SCD.
  • To analyze data from patients with type 2 diabetes mellitus, heart failure (HF), or chronic kidney disease (CKD).

Main Methods:

  • A systematic literature search was conducted across PubMed, EMBASE, and Scopus databases.
  • Relevant randomized controlled trials (RCTs) published up to February 10, 2023, were included.
  • Pooled analysis using a random-effects model was performed to calculate odds ratios (ORs) and 95% confidence intervals (CIs).

Main Results:

  • The study included 38 RCTs with 88,704 patients, followed for a mean of 1.6 years.
  • SGLT2i significantly reduced the risk of incident atrial arrhythmia (OR: 0.85, P=0.02) and SCD (OR: 0.72, P=0.02).
  • No significant difference was observed in the risk of ventricular arrhythmia (OR: 1.03, P=0.77) or cardiac arrest (OR: 0.94, P=0.67).

Conclusions:

  • SGLT2i therapy is associated with a lower risk of atrial arrhythmia and SCD in patients with type 2 diabetes mellitus and/or HF or CKD.
  • SGLT2i therapy did not demonstrate a reduced risk for ventricular arrhythmia in the studied population.
Abstract

Keywords:
SGLT2iatrial arrhythmiaheart failuresudden cardiac deathventricular arrhythmia

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